Laryngoscopy and Morbid Obesity: a Comparison of the "Sniff" and "Ramped" Positions

Collins, Jeremy; Lemmens, Harry J. M.; Brodsky, Jay B.; Brock‐Utne, John G.; Levitan, Richard M.

doi:10.1381/0960892042386869

Cited by 360 publications

(215 citation statements)

References 18 publications

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“…Various methods and degrees of head elevation have been described for intubating OR patients [3][4][5], [7][8], difficult ED patients [6], patients undergoing awake intubation [10], and even simulated patients in an ambulance setting [11]. Nevertheless, traditional supine intubation remains widespread and upright intubation remains underrepresented in research and in medical education.…”

Section: Discussionmentioning

confidence: 99%

“…Studies in the anesthesia literature suggest that elevating the external auditory meatus to the level of the sternal notch, using pillows or positioning devices to achieve a "ramped" position or "head-elevated laryngoscopy position" ("HELP"), improve laryngoscopic views [3]- [5]. Other methods of head elevation include having the patient sit during intubation [6] or simply adjusting the bed to elevate the head [7], [8].…”

Section: Introductionmentioning

confidence: 99%

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Cross-over study of novice intubators performing endotracheal intubation in an upright versus supine position

et al. 2016

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. (2016). Cross-over study of novice intubators performing endotracheal intubation in an upright versus supine position. Internal and Emergency Medicine, 1-6. https://doi.org/10.1007/s11739-016-1481-z Novice Upright Intubation 2 Abstract: There are a number of potential physical advantages to performing orotracheal intubation in an upright position. The objective of this study was to measure the success of intubation of a simulated patient in an upright versus supine position by novice intubators after brief training. This was a cross-over design study in which learners (medical students, physician assistant students, and paramedic students) intubated mannequins in both a supine (head of the bed at 0 degrees) and upright (head of bed elevated at 45 degrees) position. The primary outcome of interest was successful intubation of the trachea. Secondary outcomes included log time to intubation, Cormack-Lehane view obtained, Percent of Glottic Opening score, provider assessment of difficulty, and overall provider satisfaction with the position. There were a total of 126 participants: 34 medical students, 84 physician assistant students, and 8 paramedic students. Successful tracheal intubation was achieved in 114 supine attempts (90.5%) and 123 upright attempts (97.6%; p = 0.283). Upright positioning was associated with significantly faster log time to intubation, higher likelihood of achieving Grade I Cormack-Lehane view, higher Percent of Glottic Opening score, lower perceived difficulty, and higher provider satisfaction. A subset of 74 participants had no previous intubation training or experience. For these providers, there was a non-significant trend toward improved intubation success with upright positioning vs supine positioning (98.6% vs. 87.8%, p = 0.283). For all secondary outcomes in this group, upright positioning significantly outperformed supine positioning.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Cross-over study of novice intubators performing endotracheal intubation in an upright versus supine position

et al. 2016

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“…However, adoption of a specific ramped position for direct laryngoscopy in the population with high BMI can reduce the incidence of difficulty [113].…”

Section: Anaesthesiamentioning

confidence: 99%

Guidelines for Perioperative Care in Bariatric Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations

et al. 2016

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Background During the last two decades, an increasing number of bariatric surgical procedures have been performed worldwide. There is no consensus regarding optimal perioperative care in bariatric surgery. This review aims to present such a consensus and to provide graded recommendations for elements in an evidence-based ''enhanced'' perioperative protocol. Methods The English-language literature between January 1966 and January 2015 was searched, with particular attention paid to meta-analyses, randomised controlled trials and large prospective cohort studies. Selected studies were examined, reviewed and graded. After critical appraisal of these studies, the group of authors reached a consensus recommendation. Results Although for some elements, recommendations are extrapolated from non-bariatric settings (mainly colorectal), most recommendations are based on good-quality trials or meta-analyses of good-quality trials. Conclusions A comprehensive evidence-based consensus was reached and is presented in this review by the enhanced recovery after surgery (ERAS) Society. The guidelines were endorsed by the International Association for Surgical Metabolism and Nutrition (IASMEN) and based on the evidence available in the literature for each of the elements of the multimodal perioperative care pathway for patients undergoing bariatric surgery.

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“…4). 30 One recent review 31 summarizes these points and also highlights some of the commercially available elevation pillows for positioning of obese patients for direct laryngoscopy.…”

Section: Patient Positioningmentioning

confidence: 99%

Direct and Indirect Laryngoscopy: Equipment and TechniquesDiscussion

Collins

2014

Respir Care

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Laryngoscopy and Morbid Obesity: a Comparison of the "Sniff" and "Ramped" Positions

Abstract: The "ramped" position is superior to the standard "sniff" position for direct laryngoscopy in morbidly obese patients.

Cited by 360 publications

References 18 publications

Cross-over study of novice intubators performing endotracheal intubation in an upright versus supine position

Cross-over study of novice intubators performing endotracheal intubation in an upright versus supine position

Guidelines for Perioperative Care in Bariatric Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations

Direct and Indirect Laryngoscopy: Equipment and TechniquesDiscussion

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