Head and neck elevation beyond the sniffing position improves laryngeal view in cases of difficult direct laryngoscopy.
OBJECTIVE
To determine the influence of head and neck elevation beyond the "sniffing position" during difficult direct laryngoscopy.


METHODS
Prospective case series, with each patient serving as her or his control.


METHODS
University hospital.


METHODS
21 patients scheduled for general anesthesia and endotracheal intubation, all of whom presented with a laryngoscopic grade III view (Cormack & Lehane) during direct laryngoscopy in the sniffing position.


METHODS
An assistant applied external laryngeal pressure with his left hand and elevated the patient's head and neck above the sniffing position with his right hand to improve laryngeal view.


RESULTS
External laryngeal pressure and elevation of head and neck improved the laryngoscopic view in 19 of 21 patients to grade II (p = 0.001, Wilcoxon signed rank test). Beyond that, laryngoscopy with the neck maximally elevated enabled visualization of parts of the cords in six patients (30%).


CONCLUSIONS
Elevation of the head and neck beyond the sniffing position may improve visualization of glottic structures in cases of difficult direct laryngoscopy, leading to better intubation performance.
Schmitt
Hubert J
HJ
Department of Anesthesiology, Friedrich-Alexander-University Erlangen-Nuremberg, Krankenhausstrasse 12, D-91054 Erlangen, Germany. hubert.schmitt@kfa.imed.uni-erlangen.de
Mang
Harald
H
D000328:Adult; D000368:Aged; D000768:Anesthesia, General; D005260:Female; D005931:Glottis / Q000033:anatomy & histology*; D006257:Head / Q000033:anatomy & histology*; D006801:Humans; D007442:Intubation, Intratracheal; D007828:Laryngoscopy; D007830:Larynx / Q000033:anatomy & histology*; D008297:Male; D008875:Middle Aged; D009068:Movement / Q000502:physiology; D009333:Neck / Q000033:anatomy & histology*; D011187:Posture / Q000502:physiology*; D011446:Prospective Studies