A comparison of ramping position and sniffing position during endotracheal intubation: a systematic review and meta-analysis

Tsan, Samuel Ern Hung; Ng, Ka Ting; Lau, Jiaying; Viknaswaran, Navian Lee; Wang, Chew Yin

doi:10.1016/j.bjane.2020.10.007

Cited by 2 publications

(2 citation statements)

References 26 publications

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“…In our review, we did not find a difference between the head-elevated and supine positions on adverse events such as periintubation hypotension. However, this is still an under-investigated area because most human stud-ies are not powered to detect a difference [29]. Of note, a recent RCT showed that the head-up position in swine models may lead to reduced cerebral oxygenation during hypovolaemia, but not during normovolaemia [30].…”

Section: A) Safe Apnoea Period For Obese and Non-obese Populationmentioning

confidence: 99%

“…Indeed, it has been recommended that intubation of obese patients should be done in the ramped (headelevated) position [4]. In recent years several studies have reported that the benefits of the head-elevation on improving laryngeal exposure is not limited to the obese population alone, but extends also to non-obese patients [29,31,32]. In addition to improving laryngeal exposure, the head-elevated position could also reduce the need for ancillary airway manoeuvres and lead to faster intubation times [33].…”

Section: A) Safe Apnoea Period For Obese and Non-obese Populationmentioning

confidence: 99%

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Effectiveness of preoxygenation during endotracheal intubation in a head-elevated position: a systematic review and meta-analysis of randomized controlled trials

Tsan¹,

Viknaswaran²,

Lau³

et al. 2022

ait

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During endotracheal intubation (ETI), a difficult airway is a challenging scenario, with the potential to result in hypoxaemia, causing catastrophic consequences for both the patient and the clinicians involved. Preoxygenation before ETI is therefore of paramount importance because it serves to increase the amount of oxygen reserve in the body. This prolongs the buffer time before hypoxaemia occurs, allowing patients to tolerate a longer duration of apnoea. The clinicians in a crisis situation such as this would have a larger margin of safety, allowing them time to think and to act in securing access to the patient's airway, thus potentially saving the patient's life [1,2]. The importance of preoxygenation is such that today it is an essential part of the arsenal available to clinicians performing ETI, and it has

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Section: A) Safe Apnoea Period For Obese and Non-obese Populationmentioning

confidence: 99%

Section: A) Safe Apnoea Period For Obese and Non-obese Populationmentioning

confidence: 99%

Effectiveness of preoxygenation during endotracheal intubation in a head-elevated position: a systematic review and meta-analysis of randomized controlled trials

Tsan¹,

Viknaswaran²,

Lau³

et al. 2022

ait

View full text Add to dashboard Cite

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Comparative study of the difficulty of endotracheal intubation in sniffing and 25-degree backup positions

Ibrahem

2024

Vestn. anesteziol. reanimatol.

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Introduction. The endotracheal intubation procedure is integral to modern medicine and essential to emergency care, surgical practice and intensive care procedures.The objective was to evaluate the effect of the 25° backup position on glottic view and difficulty of intubation compared to the sniffing position in adult patients receiving general anaesthesia with endotracheal intubationMaterials and methods. The comparative clinical study was conducted in Al-Hussain Military Hospital, Baghdad, Iraq during the period from 1st of January 2022 to 1st of January 2023. A convenient sample of 150 patients who aged 18–60 years, were classified according to the American Society of Anesthesiologists as I or II, and underwent elective surgery under general anaesthesia was included in this study. These patients were allocated into two groups. Group A consisted of 75 patients who were anaesthetized in the sniffing position. Group B consisted of 75 patients who were anaesthetized in 25° backup position.Results. There was no significant difference between the sniffing position and 25° backup position regarding the number of patients who needed ancillary manoeuvres and ancillary equipment (P-values were 0.583 and 0.151, respectively). The glottic view was significantly better in the 25° backup position than the sniffing position according to the Cormack–Lehane (p = 0.001) with a significantly lower difficulty in intubation according to the intubation difficulty scale (p = 0.008).Conclusion. The 25° backup position is better than the sniffing position in glottic visualization, the difficulty of intubation and the time of intubation. Age, gender, and body mass index have no significant effects on the visualization of the glottis between the 25° backup position and the sniffing position. There was no significant difference between two regarding the number of patients who needed ancillary manoeuvres and ancillary equipment. The glottic view is significantly better in the 25° backup position than sniffing position according to the Cormack–Lehane. The mean of the time of intubation is lower in the 25° backup position compared to the sniffing position.

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A comparison of ramping position and sniffing position during endotracheal intubation: a systematic review and meta-analysis

Cited by 2 publications

References 26 publications

Effectiveness of preoxygenation during endotracheal intubation in a head-elevated position: a systematic review and meta-analysis of randomized controlled trials

Effectiveness of preoxygenation during endotracheal intubation in a head-elevated position: a systematic review and meta-analysis of randomized controlled trials

Comparative study of the difficulty of endotracheal intubation in sniffing and 25-degree backup positions

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