title: Comparison of the rate of successful endotracheal intubation between the "sniffing" and "ramped" positions in patients with an expected difficult intubation: a prospective randomized study.
abstract: BACKGROUND
  Optimal head and neck positioning and clinical experience are important factors for successful endotracheal intubation in patients with a difficult airway. This study aimed to investigate the rate of successful endotracheal intubation between the sniffing and ramped positions in patients with an expected difficult intubation.
  
  
  METHODS
  The study included 204 patients with an expected difficult intubation (airway difficulty score ≥ 8) based on the preoperative airway assessment. The patients were randomized into the following groups: group S was placed in the sniffing position, and group R was placed in the ramped position during direct laryngoscopy. The primary outcome was successful endotracheal intubation and the secondary measure was laryngeal view in the ramped or sniffing position when the operating table was placed at two different heights.
  
  
  RESULTS
  Group R showed a higher rate of successful endotracheal intubation and better laryngeal view than group S (P < 0.05). The rate of successful endotracheal intubation was higher in group R than in group S at both heights of the operating table; but, it was not different within each group. Laryngeal view was not different between the two groups and within each group when the two heights of the operating table were used. Fully trained and experienced attending anesthesiologists achieved a higher rate of successful endotracheal intubation than less experienced residents in group R (P < 0.05) but not in group S.
  
  
  CONCLUSIONS
  Ramped position and clinical experience can be important factors for laryngeal view and success rate of endotracheal intubation in patients with an expected difficult intubation.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Wonkwang University School of Medicine, Iksan, Korea.
authors.forename: Ju-Hwan
authors.initials: JH
authors.lastname: Lee
authors.affiliation: Department of Anesthesiology and Pain Medicine, Wonkwang University School of Medicine, Iksan, Korea.
authors.forename: Hoe-Chang
authors.initials: HC
authors.lastname: Jung
authors.affiliation: Department of Anesthesiology and Pain Medicine, Wonkwang University School of Medicine, Iksan, Korea.
authors.forename: Ji-Hoon
authors.initials: JH
authors.lastname: Shim
authors.affiliation: Department of Anesthesiology and Pain Medicine, Wonkwang University School of Medicine, Iksan, Korea.
authors.forename: Cheol
authors.initials: C
authors.lastname: Lee
keywords: Intubation; Laryngoscopy; Position
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