Abstract
BackgroundIn intubation using fiberoptic bronchoscope (FOB), partial or complete obstruction of upper airway makes the FOB insertion difficult. Thus, maneuvers to relieve such obstructions are recommended. There have been no studies to determine whether the sniffing or neutral position is superior for this purpose. Therefore, this study was performed to examine the effects of these two positions including vocal cord view.MethodsFifty-four patients scheduled to receive general anesthesia by orotracheal intubation were eligible for inclusion in the study with informed consent. After confirmation of proper head positioning depending on the group, the view of the vocal cord was acquired in each position. Images were reviewed using the percentage of glottic opening (POGO) score.ResultsA total of 106 images of vocal cords from 53 patients were obtained. The mean of difference of POGO score was 11.09, higher for the neutral position and standard deviation was 23.73 (p = 0.002). Neutral position increased POGO score in 31 patients and decreased POGO score in 13 patients compare to sniffing position (p = 0.017). There were no significant differences between the two head positions with regard to intubation time or degree of convenience during intubation.ConclusionsNeutral position improved the view of glottic opening than sniffing position during oral fiberoptic intubation. However, there was no difference in the difficulty of tube insertion between the two positions.Trial registrationClinical Trials.gov identifier: NCT02931019, registered on October 12, 2016.
Highlights
In intubation using fiberoptic bronchoscope (FOB), partial or complete obstruction of upper airway makes the FOB insertion difficult
The sniffing position has been recommended for laryngoscopic endotracheal intubation, its clinical benefit is controversial, and it is unclear whether this position is suitable for fiberoptic intubation [12,13,14]
Neutral position increased percentage of glottic opening (POGO) score in 31 patients and decreased POGO score in 13 patients compare to sniffing position (p = 0.017) (Fig. 2)
Summary
In intubation using fiberoptic bronchoscope (FOB), partial or complete obstruction of upper airway makes the FOB insertion difficult [1], and many methods to relieve the obstruction have been reported. A number of positions including head tilt, jaw thrust, or lingual traction have been recommended for fiberoptic intubation to relieve the obstruction at these three points [4, 5, 11]. These positions move the oropharyngeal structures anteriorly with the mouth open and an empty oropharyngeal airspace, enabling advancement of the FOB. The sniffing position has been recommended for laryngoscopic endotracheal intubation, its clinical benefit is controversial, and it is unclear whether this position is suitable for fiberoptic intubation [12,13,14]
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