The study of head elevated position for prediction of intubation difficulty using video laryngoscope in adult patients

Abstract

Background and Aim: Proper positioning of the head and neck is one of the most important steps towards laryngoscopy and tracheal intubation. We aimed to determine the effect of head elevation on the quality of laryngeal view and ease of intubation using video laryngoscopy.Method: In this prospective observational study, 100 patients who were ASA grade I/II between 18 years and 60 years with anticipated easy intubation were placed on a surgical table with non-compressible pillows under the head till horizontal alignment was achieved between the external auditory meatus and the sternal notch and the pillow height was measured. The Glottic visualization was assessed by using the modified Cormack Lehane classification and the Percentage of glottic opening (POGO) score. Intubation difficulty was assessed by the Intubation Difficulty Scale (IDS).Results: None of the patients in the study had CL Grade > 2, POGO score <50%, and IDS > 3. The mean pillow height of patients with POGO score 100% was 9.27 ± 1.27 and with POGO score 50% was 10.5 ± 1.20 (p< 0.001). Similarly, the mean pillow height of patients with CL Grade I was 9.27 ± 1.23 cm and with CL Grade II was 10.44 ± 1.20 (p< 0.001) which was highly significant. Conclusion: We concluded that alignment of the external auditory meatus and sternal notch in the horizontal plane resulted in better visualisation of the glottis and ease of intubation using a video laryngoscope. A pillow height of approximately 9cm was optimum while intubating.