Document Detail

Head and neck position for direct laryngoscopy.
MedLine Citation:
PMID:  21596871     Owner:  NLM     Status:  MEDLINE    
The sniffing position (SP) has traditionally been considered the optimal head position for direct laryngoscopy (DL). Its superiority over other head positions, however, has been questioned during the last decade. We reviewed the scarce literature on the subject to examine the evidence either in favor or against the routine use of the SP. A standard definition for the position should be used (e.g., 35° neck flexion and 15° head extension) to avoid confusion about what constitutes a proper SP and to compare the results from different studies. Although several theories were proposed to explain the superiority of the SP, the three axes alignment theory is still considered a valid anatomical explanation. Although head elevation is needed to achieve the desired neck flexion, the elevation height may vary from one patient to another depending on head and neck anatomy and size of the chest. In infants and small children, for example, no head elevation is needed because the size and shape of the head allow axes approximation in the head-flat position. Horizontal alignment of the external auditory meatus with the sternum, in both obese and non-obese patients, indicates, and can be used as a marker for, proper positioning. Analysis of the available literature supports the use of the SP for DL. To achieve a proper SP in obese patients, the "ramped" (or the back-up) position should be used. The SP does not guarantee adequate exposure in all patients, because many other anatomical factors control the final degree of visualization. However, it should be the starting head position for DL because it provides the best chance at adequate exposure. Attention to details during positioning and avoidance of minor technical errors are essential to achieve the proper position. DL should be a dynamic procedure and position adjustment should be instituted in case poor visualization is encountered in the SP.
Mohammad El-Orbany; Harvey Woehlck; M Ramez Salem
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Review     Date:  2011-05-19
Journal Detail:
Title:  Anesthesia and analgesia     Volume:  113     ISSN:  1526-7598     ISO Abbreviation:  Anesth. Analg.     Publication Date:  2011 Jul 
Date Detail:
Created Date:  2011-06-24     Completed Date:  2011-08-23     Revised Date:  2012-01-04    
Medline Journal Info:
Nlm Unique ID:  1310650     Medline TA:  Anesth Analg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  103-9     Citation Subset:  AIM; IM    
Department of Anesthesiology, Medical College of Wisconsin, 9200 West Wisconsin Ave., Milwaukee, WI 53226, USA. elorbany@mcw.ed
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MeSH Terms
Head* / physiology
Intubation, Intratracheal / methods,  standards
Laryngoscopy / methods*,  standards
Neck* / physiology
Posture* / physiology
Comment In:
Anesth Analg. 2011 Dec;113(6):1524-5; author reply 1525   [PMID:  22116972 ]

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