NCT02934347

Comparison of Glottic Views and Intubation Times in the Supine and 25 Degree Back-up Positions

• Status: Completed
• Phase: —
• Study type: Observational
• Enrollment: 781 (actual)
• Sponsor: Betsi Cadwaladr University Health Board · Other Government
• Sex: All
• Age: 18 Years
• Healthy volunteers: Not accepted

Summary

Our hypothesis is that the view of the glottis may be improved by putting all patients requiring intubation in the ramped or back up position while maintaining the classic sniffing position.

Detailed description

The sniffing position has traditionally been considered the optimal head position for direct laryngoscopy and is the usual patient position preferred by most anaesthetists. In theory, neck flexion aligns the pharyngeal and laryngeal axes, and head extension at the atlanto-occipital joint aligns the oral axis with these two axes allowing the line of sight to fall on the glottis. It is recognized as the starting head position for direct laryngoscopy because it provides the best chance of adequate exposure. However the sniffing position does not guarantee adequate exposure in all patients because many other anatomical factors control the final degree of visualization. To achieve a proper sniffing position in obese patients, the "ramped" (or the back-up) position has been used as this produces better neck flexion and head extension in these patients when compared to the horizontal supine position. Also the forces required to elevate and move the tongue and other tissues out of the line of sight are less when the patients are ramped. Our hypothesis is that the view of the glottis may be improved by putting all (ie not only obese) patients requiring intubation in the ramped or back up position while maintaining the classic sniffing position.

Conditions

• Elective Surgical Patients

Interventions

Type	Name	Description
PROCEDURE	25 degree back-up position	To test whether a 25 degree back-up position improves laryngeal views and makes intubation easier compared to the standard horizontal position

Timeline

• Start date: 2012-02-01
• Primary completion: 2014-11-01
• Completion: 2015-01-01
• First posted: 2016-10-17
• Last updated: 2017-05-11
• Results posted: 2017-03-30