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The effect of different pillow heights on direct laryngoscopic views A prospective randomised controlled study.pdf

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The effect of different pillow heights on direct laryngoscopic views A prospective randomised controlled study.pdf

Egyptian Journal of Anaesthesia (2013) 29, 279–283 Egyptian Society of Anesthesiologists Egyptian Journal of Anaesthesia /locate/egja Research Article The e?ect of di?erent pillow heights on direct laryngoscopic views: A prospective randomised controlled study Sandip Sinha *, Amitava Layek, Sulagna Bhattacharjee, Avijit Hazra I.P.G.M.E.R. – Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India Received 25 February 2013; accepted 27 April 2013 Available online 5 June 2013 KEYWORDS Sniff position; Laryngoscopic view; Pillow height Abstract Purpose: The purpose of this study was to determine the optimal pillow height for the best laryngoscopic view in adult patients scheduled for elective surgery under general anaesthesia. Methods: A total of ?fty adult patients without any anticipated dif?cult airway and who gave proper informed consent were enrolled for the study. The preanaesthetic airway evaluations were done in all the patients and were recorded. After induction of anaesthesia, the appropriate sized Macintosh blade was used for direct laryngoscopy. The assessment of direct laryngoscopic views was done at head positions without a pillow and with non-compressible pillows of heights 4.5 cm, 9 cm and 13.5 cm, respectively. The views were simultaneously imaged with a ?exible ?breoptic bronchoscope attached along the junction between the tongue and the ?ange of the Macintosh blade, and the position offering the best view was sought for which was graded by one anaesthesiologist. Results: The laryngoscopic view with the 4.5 cm pillow was signi?cantly superior to that with other pillows and without a pillow (p 0.01). The incidence of dif?cult laryngoscopy (Cormack and Lehane grade 3) was 18% without a pillow. In these cases, laryngoscopic views were improved using a 4.5 cm pillow. Conclusion: The use of a 4.5 cm pillow is recommended during direct laryngoscopy in the ‘sniff’ position for obtaining the best laryngoscopic view. a 2013 Produ