Comparative evaluation of laryngeal view and intubating conditions in two laryngoscopy positions-attained by conventional 7 cm head raise and that attained by horizontal alignment of external auditory meatus - sternal notch line – using an inflatable pillow - A prospective randomised cross-over trial

Anant V Pachisia; Kavita R Sharma; Jaspal S Dali; Mona Arya; Neha Pangasa; Rakesh Kumar

doi:10.4103/joacp.JOACP_35_19

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ORIGINAL ARTICLE

Year : 2019 | Volume : 35 | Issue : 3 | Page : 312-317

Comparative evaluation of laryngeal view and intubating conditions in two laryngoscopy positions-attained by conventional 7 cm head raise and that attained by horizontal alignment of external auditory meatus - sternal notch line – using an inflatable pillow - A prospective randomised cross-over trial

Anant V Pachisia¹, Kavita R Sharma², Jaspal S Dali², Mona Arya², Neha Pangasa³, Rakesh Kumar²
¹ Department of Critical Care Medicine, Asian Institute of Medical Sciences, Faridabad, Haryana; Department of Anaesthesiology and Intensive Care, Maulana Azad Medical College and Associated Hospitals, New Delhi, India
² Department of Anaesthesiology and Intensive Care, Maulana Azad Medical College and Associated Hospitals, New Delhi, India
³ Department of Anaesthesiology and Intensive Care, Maulana Azad Medical College and Associated Hospitals; Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India

Correspondence Address:
Dr. Neha Pangasa
Department of Anaesthesiology, Pain Medicine and Critical Care, Room No. 5011, 5th Floor, Teaching Block, All India Institute of Medical Sciences, New Delhi - 110 029
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/joacp.JOACP_35_19

Background and Aims: We compared the laryngoscopy position attained by a 7-cm-high pillow (Sniffing position-SP) with that attained by horizontal alignment of external auditory meatus-sternal notch (AM-S) line-using variable height inflatable pillow. Material and Methods: This prospective-randomised-cross-over study included 50 patients in each group. Group-AM-S: A 7 cm uncompressible pillow was used for attaining first laryngoscopy position, followed by horizontal alignment of external auditory meatus-sternal notch (AM-S) line-using an inflatable pillow for attaining second laryngoscopy position followed by intubation. Group-SP: Horizontal alignment of external auditory meatus-sternal notch (AM-S) line-was done using an inflatable pillow for attaining first laryngoscopy position, followed by using 7 cm uncompressible pillow for second laryngoscopy position followed by intubation. The CL-grade, Intubation Difficulty Score (IDS) and time to intubation were compared in both positions. The head raise (in cm) required for attaining AM-S alignment was noted. Results: CL-grade-I was obtained in significantly larger number of patients with AM-S alignment position than with 7 cm head raise (P = 0.004). CL-grade-III was obtained in significantly lesser number of patients with AM-S alignment (P = 0.002). Mean IDS with AM-S alignment (1.18 ± 1.69) was significantly less than with 7cm head raise (2 ± 1.59; P = 0.007) and time to intubation with AM-S alignment (17.33 ± 4.52 s) was significantly less than that with 7cm head raise (18.94 ± 4.64 s; P = 0.041). The mean head rise required to achieve AM-S line alignment was 4.920 ± 1.460 cm. Conclusion: External Auditory Meatus-Sternal notch (AM-S) line alignment provides better laryngeal view, better intubating conditions and requires lesser time to intubate as compared to a conventional 7-cm-head raise. The size of pillow used for head raise should be individualised.

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