5: Comparison of intubating conditions with sniffing versus ramp position in non-obese patients

Abstract

Background and Aims:Proper positioning is essential in laryngoscopy for optimal laryngeal visualisation. In sniffing position (SP), the neck is flexed 35° on the chest and the head extended at the atlanto-occipital joint to produce a 15° angle between the facial and the horizontal planes in normal-weight patients. This was considered the optimal position for successful direct laryngoscopy.Rapid Airway Management Position (RAMP) was introduced by Collins in 2004 in which the patient’s external auditory meatus and sternal notch are in the same horizontal plane.Methods:After Institutional Ethics Committee approval for a randomised prospective study, 50 patients of age 18-60 years, with body mass index < 25, of American Society of Anesthesiologists(ASA) I and II, having Mallampati classification (MPC) I and II, mouth opening angle (MOA)≥2, thyromental distance>6.5, undergoing routine elective surgery under general anaesthesia were divided into Group S (SP) and Group R(RAMP) (25 each). Patients in Group S were given 8 cm high pillow to elevate the occiput while that in Group R were laid on a ramp made of folded blankets. After laryngoscopy, both groups were compared for number of single attempt successful intubations, intubation time, Cormack Lehane (CL) view and need for ancillary manoeuvres.Results:Intubation time with RAMP was significantly lesser than SP. (p < 0.0001). Also, RAMP was associated with greater number of single attempt intubations (p= 0.034), better CL view (p=0.041) and lesser number of ancillary maneuvers(p=0.03).Conclusion:RAMP is superior to SP in terms of better laryngeal view, faster intubation time and lesser need for external manoeuvres.Sniffing positionRamp P 24.4±1.24 sec20.2±1.42 secP<0.0001