AKhil Rao U.K.1, Athira Soman2, Anuradha Yadav3, Yashwant R.4, Sucheth Sharat5
BACKGROUND
Endotracheal intubation for the purpose of providing anaesthesia was first
described by William Mc Ewan. Jackson1 stressed the importance of anterior
flexion of the lower cervical spine, in addition to obvious extension of the
atlanto-occipital joint. Sniffing position has been commonly advocated as a
standard head positioning for direct laryngoscopy which is achieved by flexion of
the neck on chest and extension of the head at the atlanto-occipital joint.
Present study was designed to evaluate the glottis view and ease of intubation
achieved with direct laryngoscopy in the sniffing position with that of 25 degree
backup position in a study group of 100 patients divided in 2 groups of 50 each.
METHODS
This study is a controlled comparative study. Controlled trial in 50 consecutive
patients in each group [Group I and Group II] was conducted on patients who
underwent elective surgery under general anaesthesia.
Inclusion Criteria - General anaesthesia with endotracheal intubation, Aged 18 to
60 years, American society of Anaesthesiologists (ASA) grades I and II.
Exclusion Criteria - Patients with body mass index more than 30 kg/m2.
1. Bucked teeth.
2. Restricted neck movement.
3. Inter-incisor gap less than 35 mm.
4. Thyro-mental distance less than 6 mm.
5. Patients with risk of regurgitation and aspiration.
6. Pharyngeal pathology.
7. Limitation of anterior and posterior movement of mandible
8. Pregnant patients
Groups were-
Group I – Sniffing position
Group II– 25 degree back up position
RESULTS
The glottis visualization was assessed by Cormack Lehane grading which
revealed that glottis view was better in 25 degree backup position than sniffing
position.
CONCLUSIONS
In our prospective randomized study in a series of 50 patients undergoing
general anaesthesia in SIMS & RC, intubation difficulty scale (IDS) score was
better in 25 degree backup position than sniffing position. It implies glottis view
is better in 25 degree backup position than sniffing position.
