Comparison of neutral and sniffing position for ease of endotracheal intubation using Airtraq optical laryngoscope-A randomized trial

Abstract

Background: Traditionally, the sniffing position has been considered a standard head and neck position during direct laryngoscopy. The perfect head and neck position for video laryngoscopy has yet not been described. Hence, we planned the present study to compare the neutral and sniffing position for ease of intubation using Airtraq. Methods: A total of 60 patients were randomized into two groups. Patients were intubated with their heads in neutral and sniffing positions in Group NP and SP, respectively. Ease of intubation was taken as a primary outcome. Laryngoscopy time, intubation time, percentage of glottic opening (POGO), the number of attempts for Airtraq and endotracheal tube, insertion of Airtraq, the success rate of intubation, optimization maneuvers, and complications were taken as secondary objectives. Data were analyzed using SPSS software, V.22.(1). Results: For ease of intubation, we used a visual analog scale (VAS) and Fremantle scores. VAS score (mm) in the median (interquartile range [IQR]) was 32 (24, 34) and 28 (24, 32) in NP and SP groups, respectively (P = 0.37). Twenty-four (80%) patients in NP and 23 (76.67%) patients in the SP group had a Fremantle score of F1 (full view; easy intubation). One (3.33%) patient in both groups had a score of F2 (full view; modified intubation). Five (16.67%) and six (20%) patients in NP and SP groups had P1 scores. Overall, there was no difference in Fremantle’s score between the groups (P = 0.945). The number of attempts, optimization maneuvers, and complications were statistically comparable between the groups. Conclusion: There is no difference in the ease of intubation between the neutral and sniffing position using the Airtraq optical laryngoscope.

Keywords

• endotracheal tube
• glottis
• intubation
• video laryngoscope
• key message:
• to find the perfect head and neck position for video laryngoscopy.