Abstract PR527

Abstract

Background & Objectives: Proper positioning of the head is essential for optimal laryngeal visualization during direct laryngoscopy. 25° back-up position has been shown to improve laryngeal view when compared with the flat supine position during direct laryngoscopy1. However, it has not been compared with the sniffing position (SP). In this prospective, randomized, crossover study we evaluated, the effect of 25° back- up position on direct laryngoscopic view compared to the sniffing position in adult patients receiving general anesthesia with endotracheal intubation. We also compared the laryngeal views in both positions with optimum external laryngeal manipulation (ELM). Materials & Methods: After Institutional Ethics Committee approval and written informed consent, 100 patients were randomized into two groups (S and B). Laryngoscopy was performed using MacIntosh laryngoscope blade size 3. Sniffing position was obtained by placing a non-compressible pillow of appropriate height so as to achieve the horizontal alignment of external auditory meatus to sternal notch2. In group S after induction of anesthesia and muscle paralysis, first laryngoscopy (L1) was done in 25° back-up position followed by laryngoscopy (L2) and intubation in sniffing position. In group B first laryngoscopy (L1) was done in sniffing position followed by second laryngoscopy (L2) and intubation in 25° back-up position. Cormack Lehane (CL) grade of laryngeal view was noted during both the laryngoscopies without and with ELM. Results: In our study we observed that 25° back-up position gives better laryngeal visualization as compared to sniffing position (p = 0.0000149). The laryngeal view improved in 33% patients, remained same in 44% and worsened in 23% patients during 25° back-up position as compared to sniffing position. However, with ELM sniffing position was better than 25° back-up position for laryngeal visualization (p = 0.00000238). Conclusion: During direct laryngoscopy, the laryngeal view, as assessed by Cormack Lehane grade, improves significantly in the 25° back-up position when compared with the sniffing position. With ELM sniffing position is better than 25° back-up position for laryngeal visualization.