Comparative Evaluation of Glottic Visualisation and Ease of Intubation Using Sniffing Position and Simple Head Extension during Laryngoscopy in Elective Surgical Procedures-A Randomised Prospective Observational Study

Background and Aims: Maintenance of a patient airway is a fundamental responsibility of the anaesthesiologist and tracheal intubation remains one of the commonest means of establishing definitive airway. The Sniffing Position (SP) is traditionally recommended as the standard head position for optimal glottic exposure. However, intubation is sometimes easier with just simple cervical extension without inducing neck flexion. So, we conducted this study to evaluate the glottic visualisation and ease of intubation using sniffing position and simple head extension during laryngoscopy. Methods: Two hundred American Society of Anesthesiologists (ASA) physical grade I and II patients scheduled for surgery under general anaesthesia were randomly allocated to be intubated in sniffing position (Group I) or simple head extension (Group II). Glottic visualization and ease of intubation were assessed. Results: The baseline demographic variables and haemodynamic parameters were statistically comparable between the two groups. In Group I, there were more number of patients (62%) with Cormack and Lehane grade I as compared to Group II (40%) suggesting that glottic visualization was significantly better in sniffing position (p<0.05). On comparison of various intubation difficulty scale parameters in both the groups it was observed that intubation was easier in sniffing position as compared to simple head extension. The total Intubation Difficulty Scale score indicated that ease of tracheal intubation was significantly lower (p<0.05) in Group I as compared to Group II. Conclusion: sniffing position provides better glottic visualization and ease of intubation as compared to simple head extension during direct laryngoscopy and endotracheal intubation.