Sniffing Position: Is it Just a Gas?

Arunangshu Chakraborty

Abstract

Optimal positioning of the head and neck is crucial for a favourable laryngeal visualization. Sniffing Position (SP) is known to provide good visualization of the glottis during direct laryngoscopy, facilitating intubation. Various studies have however, challenged the superiority of sniffing position. We did a literature search and reviewed various studies comparing the sniffing position with simple head extension to study the glottic view and difficulty in intubation during direct laryngoscopy. Several factors such as ease of bag mask ventilation, intubation difficulty, laryngoscopic views and posture of the anaesthesiologist during laryngoscopy and tracheal intubation were noted in the reviewed studies. Most of the studies noted that simple head extension needed more lifting force, increased use of External Laryngeal Manipulation (ELM), and an increased use of alternate techniques during intubation when compared to the sniffing position. Based on the review of available literature we concluded that compared to head extension only position, the sniffing position should be used as a standard head position for intubation attempts under general anaesthesia.