title: [How to improve positioning of the head--the sniffing position, considered to be suitable for endotracheal intubation].
abstract: BACKGROUND
  The sniffing position, a combination of flexion of the neck and extension of the head, is considered to be suitable for the performance of endotracheal intubation. To place a patient in this position, anesthesiologists usually put a pillow under a patient's occiput. However, with a regular pillow, the resulting extension of the head tends to be suboptimal.
  
  
  METHODS
  In an attempt to improve positioning of the head, we started using "a triangular pillow". The name of this pillow comes from its shape in the sagittal section. A patient's head rests on a slope of the pillow so that it assumes an extended position.
  
  
  RESULTS
  In this retrospective study, we compared the triangular pillow and the regular pillow employing the laryngoscopic view grade (Cormack grade) and times for tracheal intubation trial. We found that the triangular pillow group showed lower Cormack grades, compared with the regular pillow group. And in the first attempt, the success rate of the triangular pillow group was higher than that of the regular pillow group.
  
  
  CONCLUSIONS
  The triangular pillow improves the laryngoscopic view and facilitates endotracheal intubation by optimizing a patient's head position.
authors.affiliation: Department ofAnesthesiology, Nishijin Hospital, Kyoto 602-8319.
authors.forename: Yoko
authors.initials: Y
authors.lastname: Okayama
authors.forename: Miho
authors.initials: M
authors.lastname: Inoue
authors.forename: Hiromi
authors.initials: H
authors.lastname: Nakagawa
authors.forename: Takae
authors.initials: T
authors.lastname: Ibuki
authors.forename: Teiji
authors.initials: T
authors.lastname: Sawa
mesh_terms: D001512:Bedding and Linens; D005260:Female; D006257:Head; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation / Q000379:methods*; D007828:Laryngoscopy; D008297:Male; D008875:Middle Aged; D011187:Posture; D012189:Retrospective Studies