Comparison of Sniffing Position and Simple Head Extension for Visualization of Glottis During Direct Laryngoscopy

The prospective randomized study comprised of 200 patients in the age group of 20 to 60 years, belonging to ASA physical status grade I or II, undergoing elective surgery under general anaesthesia with tracheal intubation. The aim was to compare sniffing position with simple head extension for visualization of glottis during direct laryngos-copy and ease of tracheal intubation. All the patients were randomly divided in two groups of 100 each: Group A (sniffing position) and Group B (simple head extension). Direct laryngoscopy was done using Macintosh laryngo-scope (size 3 blade). Glottic visualization during laryngoscopy was assessed using modified Cormack and Lehane classification. After laryngoscopy, tracheal intubation was performed and intubation difficulty score (IDS) recorded. Both groups were comparable regarding glottic visualization (P>0.05). All intubation difficulty score variables (N 1 to N 7 ) were comparable in the two groups except N 3 variable, which was significantly higher (P< 0.05) in simple head extension position. Total IDS was significantly better in sniffing position than simple head extension position (P< 0.05). To conclude, glottis visualization and intubation difficulty score are better in sniffing position as compared to simple head extension. It is too early to abandon this gold standard (sniffing position) for direct laryngoscopy and tracheal intubation