Dhar Mridul, Karim Habib Md Reazaul, Rajaram Narayanan, Prakash Avinash, Sahoo Sarasa K, Narayan Anilkumar
Department of Anaesthesiology, Andaman and Nicobar Islands Institute of Medical Sciences, Port Blair, India.
Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India.
Indian J Anaesth. 2018 May;62(5):344-349. doi: 10.4103/ija.IJA_672_17.
The sniffing position has been most commonly used for positioning of the head and neck to facilitate tracheal intubation. However, the optimum degree of head elevation for the optimal laryngeal view is not well studied, especially in non-Western countries. The present study was aimed to compare the use of a fixed height pillow versus a customised pillow (CP) height for head elevation, in terms of glottis visualisation and time required for tracheal intubation.
With research and ethics committee approval from the institute, this randomised study was conducted among patients of both sexes aged 16 years or more and American Society of Anesthesiologists physical Status I to IV. A total of 134 patients were randomly allocated into routinely used fixed-sized pillow (FP) and CP group (to achieve horizontal alignment of external auditory meatus [EAM] and sternal notch). Primary and secondary outcomes were Cormack-Lehane (C-L) grade of glottic visualisation and time required for tracheal intubation, respectively. They were compared using unpaired -test and Fisher's exact test as applicable; < 0.05 was considered statistically significant.
One hundred and nineteen patients completed the study. Both groups were similar in terms of demographic and external airway measurements. The mean ± standard deviation height of pillow required in Group CP was 6.26 ± 0.97 cm. Group FP had C-L Grade 3 view more often than Group CP (28.33% vs. 13.56%). In patients with modified Mallampati (MMP) Grade ≥3, the C-L grades and time required for intubation were both significantly lower in group CP. The time required for tracheal intubation was significantly lower in group CP ( = 0.04), even though the C-L grades were similar.
Customising pillow for head elevation to horizontally align the EAM and the sternal notch gives better glottic visualisation and intubating conditions in patients with higher MMP grades.
嗅物位是头颈部定位以利于气管插管时最常用的体位。然而，关于获得最佳喉镜视野的最佳头部抬高程度，尚未得到充分研究，尤其是在非西方国家。本研究旨在比较使用固定高度枕头与定制枕头（CP）抬高头部时，声门可视化情况及气管插管所需时间。
经研究所研究与伦理委员会批准，本随机研究纳入年龄16岁及以上、美国麻醉医师协会身体状况分级为I至IV级的男女患者。共134例患者被随机分为常规使用的固定尺寸枕头（FP）组和CP组（使外耳道[EAM]与胸骨切迹水平对齐）。主要和次要结局分别为声门可视化的Cormack-Lehane（C-L）分级和气管插管所需时间。根据适用情况，使用不成对t检验和Fisher精确检验进行比较；P<0.05被认为具有统计学意义。
119例患者完成研究。两组在人口统计学和外部气道测量方面相似。CP组所需枕头的平均±标准差高度为6.26±0.97厘米。FP组C-L 3级视野出现的频率高于CP组（28.33%对13.56%）。在改良Mallampati（MMP）分级≥3的患者中，CP组的C-L分级和插管所需时间均显著更低。CP组气管插管所需时间显著更低（P = 0.04），尽管C-L分级相似。
定制用于抬高头部的枕头以使EAM与胸骨切迹水平对齐，可为MMP分级较高的患者提供更好的声门可视化和插管条件。
