Comparison of ease of endotracheal intubation and laryngeal view between “sniffing” and “ramped” positions- a prospective study

Background and Aims: Optimal head and neck positioning is very important for successful endotracheal intubation in patients with a difficult airway. Our study aims to investigate whether the use of ramped position can help decrease the incidence of unanticipated difficult airway. Our primary objective is to compare ease of endotracheal intubation between standard and ramped positions. Our secondary objective is to compare the laryngeal view between standard and ramped positions. Methods: This is a prospective study conducted in 150 patients belonging to American Society of Anaesthesiologists physical status (ASA PS) I, III, III between the age group of 18-60 years who underwent elective surgery under general anaesthesia (GA). Airway assessment was done preoperatively and patients with Airway Difficulty Score (ADS) less than 8 were selected for the study. Group R was placed in ramped position and Group S was placed in sniffing morning air/standard position. Both groups were assessed intraoperatively for ease of intubation and laryngeal view. Statistical analysis was done using Statistical Packages for the Social Sciences (SPSS) 11.0 software. Results: Time taken for intubation was more in ramped position than standard position (P=0.006). Number of first attempts was more in standard position compared to ramped position and second and third attempts were more in ramped position than standard position (P =0.003). Better laryngeal view was obtained in standard position than ramped position (P=0.032). Conclusion: Ramped position required more time to intubate, more attempts at intubation and showed more difficult laryngeal views compared to standard position.