Comparison of glottic views and intubation times in the supine and 25 degree back-up positions

on behalf of the Anaesthetic Department at Glan Clwyd Hospital

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: We explored whether positioning patients in a 25° back-up sniffing position improved glottic views and ease of intubation. Methods: In the first part of the study, patients were intubated in the standard supine sniffing position. In the second part, the back of the operating table was raised 25° from the horizontal by flexion of the torso at the hips while maintaining the sniffing position. The best view obtained during laryngoscopy was assessed using the Cormack and Lehane classification and Percentage of Glottic Opening (POGO) score. The number of attempts at both laryngoscopy and tracheal intubation, together with the use of ancillary equipment and manoeuvres were recorded. The ease of intubation was indirectly assessed by recording the time interval between beginning of laryngoscopy and insertion of the tracheal tube. Results: Seven hundred eighty one unselected surgical patients scheduled for non-emergency surgery were included. In the back-up position, ancillary laryngeal manoeuvres, which included cricoid pressure, backwards upwards rightward pressure and external laryngeal manipulation, were required less frequently (19.6 % versus 24.6 %, p = 0.004). The time from beginning of laryngoscopy to insertion of the tracheal tube was 14 % shorter (median time 24 versus 28 s, p = 0.031) in the back-up position. There was no significant difference in glottic views. Conclusions: The 25° back-up position improved the ease of intubation as judged by the need for fewer ancillary manoeuvres and shorter time for intubation. Trial registration: ClinicalTrials.gov Identifier: NCT02934347registered retrospectively on 14th Oct 2016.

Original languageEnglish
Article number113
JournalBMC Anesthesiology
Volume16
Issue number1
DOIs
Publication statusPublished - 16-11-2016
Externally publishedYes

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Tongue
Laryngoscopy
Intubation
Operating Tables
Patient Positioning
Pressure
Torso
Supine Position
Hip
Equipment and Supplies

All Science Journal Classification (ASJC) codes

  • Anesthesiology and Pain Medicine

Cite this

on behalf of the Anaesthetic Department at Glan Clwyd Hospital. / Comparison of glottic views and intubation times in the supine and 25 degree back-up positions. In: BMC Anesthesiology. 2016 ; Vol. 16, No. 1.
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title = "Comparison of glottic views and intubation times in the supine and 25 degree back-up positions",
abstract = "Background: We explored whether positioning patients in a 25° back-up sniffing position improved glottic views and ease of intubation. Methods: In the first part of the study, patients were intubated in the standard supine sniffing position. In the second part, the back of the operating table was raised 25° from the horizontal by flexion of the torso at the hips while maintaining the sniffing position. The best view obtained during laryngoscopy was assessed using the Cormack and Lehane classification and Percentage of Glottic Opening (POGO) score. The number of attempts at both laryngoscopy and tracheal intubation, together with the use of ancillary equipment and manoeuvres were recorded. The ease of intubation was indirectly assessed by recording the time interval between beginning of laryngoscopy and insertion of the tracheal tube. Results: Seven hundred eighty one unselected surgical patients scheduled for non-emergency surgery were included. In the back-up position, ancillary laryngeal manoeuvres, which included cricoid pressure, backwards upwards rightward pressure and external laryngeal manipulation, were required less frequently (19.6 {\%} versus 24.6 {\%}, p = 0.004). The time from beginning of laryngoscopy to insertion of the tracheal tube was 14 {\%} shorter (median time 24 versus 28 s, p = 0.031) in the back-up position. There was no significant difference in glottic views. Conclusions: The 25° back-up position improved the ease of intubation as judged by the need for fewer ancillary manoeuvres and shorter time for intubation. Trial registration: ClinicalTrials.gov Identifier: NCT02934347registered retrospectively on 14th Oct 2016.",
author = "{on behalf of the Anaesthetic Department at Glan Clwyd Hospital} and Reddy, {Raj M.} and Manish Adke and Pranava Patil and Irina Kosheleva and Saxon Ridley and S. Agarwal and S. Ajam and A. Bhatnager and L. Bandara and C. Beaton and G. Bugelli and S. Burgess and J. Butler and S. Chugani and D. Cliciovans and D. Counsell and J. Dougherty and L. Dumby and A. Evans and C. Fulton and S. Ganesh and C. Goodman and L. Griffiths and I. Gyorimolnar and Z. Hajat and P. Hamer and E. Hosking and S. Hugo and A. Idries and A. Jacob and P. Jirasck and D. John and N. Juganaru and N. Kelly and A. Khalil and I. Khan and M. Khater and P. Kucharski and G. Leslie and M. Liutkus and V. Machineni and M. Marimuthu and P. Michael and A. Moss and G. Mula and N. Murphy and D. Pausan and R. Pugh and M. Quarmby and S. Shenoy",
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Comparison of glottic views and intubation times in the supine and 25 degree back-up positions. / on behalf of the Anaesthetic Department at Glan Clwyd Hospital.

In: BMC Anesthesiology, Vol. 16, No. 1, 113, 16.11.2016.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Comparison of glottic views and intubation times in the supine and 25 degree back-up positions

AU - on behalf of the Anaesthetic Department at Glan Clwyd Hospital

AU - Reddy, Raj M.

AU - Adke, Manish

AU - Patil, Pranava

AU - Kosheleva, Irina

AU - Ridley, Saxon

AU - Agarwal, S.

AU - Ajam, S.

AU - Bhatnager, A.

AU - Bandara, L.

AU - Beaton, C.

AU - Bugelli, G.

AU - Burgess, S.

AU - Butler, J.

AU - Chugani, S.

AU - Cliciovans, D.

AU - Counsell, D.

AU - Dougherty, J.

AU - Dumby, L.

AU - Evans, A.

AU - Fulton, C.

AU - Ganesh, S.

AU - Goodman, C.

AU - Griffiths, L.

AU - Gyorimolnar, I.

AU - Hajat, Z.

AU - Hamer, P.

AU - Hosking, E.

AU - Hugo, S.

AU - Idries, A.

AU - Jacob, A.

AU - Jirasck, P.

AU - John, D.

AU - Juganaru, N.

AU - Kelly, N.

AU - Khalil, A.

AU - Khan, I.

AU - Khater, M.

AU - Kucharski, P.

AU - Leslie, G.

AU - Liutkus, M.

AU - Machineni, V.

AU - Marimuthu, M.

AU - Michael, P.

AU - Moss, A.

AU - Mula, G.

AU - Murphy, N.

AU - Pausan, D.

AU - Pugh, R.

AU - Quarmby, M.

AU - Shenoy, S.

PY - 2016/11/16

Y1 - 2016/11/16

N2 - Background: We explored whether positioning patients in a 25° back-up sniffing position improved glottic views and ease of intubation. Methods: In the first part of the study, patients were intubated in the standard supine sniffing position. In the second part, the back of the operating table was raised 25° from the horizontal by flexion of the torso at the hips while maintaining the sniffing position. The best view obtained during laryngoscopy was assessed using the Cormack and Lehane classification and Percentage of Glottic Opening (POGO) score. The number of attempts at both laryngoscopy and tracheal intubation, together with the use of ancillary equipment and manoeuvres were recorded. The ease of intubation was indirectly assessed by recording the time interval between beginning of laryngoscopy and insertion of the tracheal tube. Results: Seven hundred eighty one unselected surgical patients scheduled for non-emergency surgery were included. In the back-up position, ancillary laryngeal manoeuvres, which included cricoid pressure, backwards upwards rightward pressure and external laryngeal manipulation, were required less frequently (19.6 % versus 24.6 %, p = 0.004). The time from beginning of laryngoscopy to insertion of the tracheal tube was 14 % shorter (median time 24 versus 28 s, p = 0.031) in the back-up position. There was no significant difference in glottic views. Conclusions: The 25° back-up position improved the ease of intubation as judged by the need for fewer ancillary manoeuvres and shorter time for intubation. Trial registration: ClinicalTrials.gov Identifier: NCT02934347registered retrospectively on 14th Oct 2016.

AB - Background: We explored whether positioning patients in a 25° back-up sniffing position improved glottic views and ease of intubation. Methods: In the first part of the study, patients were intubated in the standard supine sniffing position. In the second part, the back of the operating table was raised 25° from the horizontal by flexion of the torso at the hips while maintaining the sniffing position. The best view obtained during laryngoscopy was assessed using the Cormack and Lehane classification and Percentage of Glottic Opening (POGO) score. The number of attempts at both laryngoscopy and tracheal intubation, together with the use of ancillary equipment and manoeuvres were recorded. The ease of intubation was indirectly assessed by recording the time interval between beginning of laryngoscopy and insertion of the tracheal tube. Results: Seven hundred eighty one unselected surgical patients scheduled for non-emergency surgery were included. In the back-up position, ancillary laryngeal manoeuvres, which included cricoid pressure, backwards upwards rightward pressure and external laryngeal manipulation, were required less frequently (19.6 % versus 24.6 %, p = 0.004). The time from beginning of laryngoscopy to insertion of the tracheal tube was 14 % shorter (median time 24 versus 28 s, p = 0.031) in the back-up position. There was no significant difference in glottic views. Conclusions: The 25° back-up position improved the ease of intubation as judged by the need for fewer ancillary manoeuvres and shorter time for intubation. Trial registration: ClinicalTrials.gov Identifier: NCT02934347registered retrospectively on 14th Oct 2016.

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U2 - 10.1186/s12871-016-0280-4

DO - 10.1186/s12871-016-0280-4

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JO - BMC Anesthesiology

JF - BMC Anesthesiology

SN - 1471-2253

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ER -