Key result
The modified ramped position improved the ease of mask ventilation (79.6% vs 63.4%, P=0.023) and laryngoscopic view (68.8% vs 52.7%, P=0.014) compared to the classical morning sniffing position.
Why the study?
Unanticipated difficult intubation remains a critical problem for anesthesiologists, prompting evaluation of the modified ramped position versus the classical morning sniffing position in the general population.
Does the modified ramped position improve mask ventilation and laryngoscopic view compared to the classical morning sniffing position in patients undergoing elective surgeries?
Does the modified ramped position improve mask ventilation and laryngoscopic view compared to the classical morning sniffing position in patients undergoing elective surgeries?
Answers are grounded in this paper and cite their sources.
The modified ramped position provides better outcomes for mask ventilation and laryngoscopic view compared to the classical morning sniffing position during elective surgeries.
Background: The prevalence of unanticipated difficult intubation is low but consistent making it a critical problem for anesthesiologists in an operating room. To overcome such life-threatening situations, we have attempted to estimate the benefits of the modified ramped position (MRP) over the classical morning sniffing position (MSP) in the general population. To achieve MRP, we have used the Hasanin pillow which was earlier tried for obese patients. Aim and Objectives: The aim of the study was to assess the usefulness of MRP for laryngoscopy and intubation compared to the traditional MSP. Methodology: One hundred and eighty-six patients belonging to the American Society of Anesthesiologists – PS I, II, and III scheduled for elective surgeries were enrolled. Group A patients (93) were placed in the MSP, whereas Group B (93) patients were placed in the MRP. Degree of difficulty with mask ventilation, Cormack–Lehane grading (CLG) on laryngoscopy, and intubation difficulty scale (IDS) score were assessed. Results: Demographic characteristics were comparable. Mask ventilation was easy for 79.6% participants in the MRP group compared to 63.4% of the MSP group ( P = 0.023). CLG view during laryngoscopy was easy for 68.8% (1, 2a grade) in MRP compared to 52.7% in MSP ( P = 0.014). Laryngoscopy and intubation were more difficult (IDS score > 5) with 4.3% in MSP compared to 3.2% in MRP ( P = 0.086). Conclusion: MRP provided better outcomes in terms of mask ventilation, laryngoscopic view, and ease of intubation with IDS compared to MSP. This could be important in clinical settings where rapid and effective airway management is crucial.
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Sindhuja et al. (2024) studied Elective surgery requiring intubation (n=186). Modified ramped position (MRP) vs. Classical morning sniffing position (MSP) was evaluated on Easy mask ventilation (p=0.023). The modified ramped position improved the ease of mask ventilation (79.6% vs 63.4%, P=0.023) and laryngoscopic view (68.8% vs 52.7%, P=0.014) compared to the classical morning sniffing position.
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