University of Alberta, Edmonton, Canada.
Br J Anaesth. 2010 Apr;104(4):496-500. doi: 10.1093/bja/aeq020. Epub 2010 Feb 18.
The 'sniffing position' is widely promoted for teaching airway positioning before intubation, but whether this analogy results in novices placing the head and neck appropriately has not been evaluated. We compared performance following the sniffing position instructions with an alternate analogy, 'win with the chin'. We also compared performance following simple anatomic instructions and no instructions.
A randomized controlled study of medical students and PGY1 registrars in Surgery and Internal Medicine was performed. Subjects independently positioned a simulator manikin head and neck based upon their understanding of four written instructions in random order: (i) the 'sniffing position'; (ii) the 'win with the chin' analogy, (iii) anatomic instructions; and (iv) no instructions (control). Digital photographs following each instruction were analysed by two airway experts for (i) adequacy of overall positioning and (ii) the three components of airway positioning.
Eighty-one volunteers participated. The positioning was adequate most often (43.2%) following the 'win with the chin' analogy when compared with the other instructions (37.0% anatomic instructions; 19.8% control; 14.8% 'sniffing position' analogy). Positioning following the 'sniffing position' instructions was not different from no instruction (P=0.53). The 'win with the chin' and anatomic instructions were significantly better than no instructions (P=0.002 and 0.023, respectively).
The 'win with the chin' analogy resulted in adequate airway positioning significantly more often than the 'sniffing position' or control. It also maintained atlanto-occipital extension compared with anatomic instructions. Overall, 'win with the chin' was a superior teaching analogy and could replace the 'sniffing position' analogy.
“嗅探位”在气道定位的插管前教学中被广泛推广，但这种类比是否能使新手正确放置头颈部尚未得到评估。我们比较了嗅探位指令和替代类比“下巴取胜”的表现，以及单纯的解剖学指令和无指令的表现。
对外科和内科的医学生和 PGY1 住院医师进行了一项随机对照研究。受测者根据他们对四个随机顺序的书面指令的理解，独立地定位模拟人头颈部：（一）“嗅探位”；（二）“下巴取胜”类比；（三）解剖学指令；（四）无指令（对照组）。每次指令后，两名气道专家通过数字照片分析（一）整体定位的充分性和（二）气道定位的三个组成部分。
81 名志愿者参与了研究。与其他指令（解剖学指令 37.0%，对照组 19.8%，“嗅探位”类比 14.8%）相比，“下巴取胜”类比时定位最充分（43.2%）。“嗅探位”指令的定位与无指令时没有区别（P=0.53）。“下巴取胜”和解剖学指令明显优于无指令（P=0.002 和 0.023）。
“下巴取胜”类比比“嗅探位”或对照组更能有效地实现气道定位，且能保持寰枕伸展。总的来说，“下巴取胜”是一种优越的教学类比，可以替代“嗅探位”类比。
