Comparative study of the difficulty of endotracheal intubation in sniffing and 25-degree backup positions

Introduction. The endotracheal intubation procedure is integral to modern medicine and essential to emergency care, surgical practice and intensive care procedures.The objective was to evaluate the effect of the 25° backup position on glottic view and difficulty of intubation compared to the sniffing position in adult patients receiving general anaesthesia with endotracheal intubationMaterials and methods. The comparative clinical study was conducted in Al-Hussain Military Hospital, Baghdad, Iraq during the period from 1st of January 2022 to 1st of January 2023. A convenient sample of 150 patients who aged 18–60 years, were classified according to the American Society of Anesthesiologists as I or II, and underwent elective surgery under general anaesthesia was included in this study. These patients were allocated into two groups. Group A consisted of 75 patients who were anaesthetized in the sniffing position. Group B consisted of 75 patients who were anaesthetized in 25° backup position.Results. There was no significant difference between the sniffing position and 25° backup position regarding the number of patients who needed ancillary manoeuvres and ancillary equipment (P-values were 0.583 and 0.151, respectively). The glottic view was significantly better in the 25° backup position than the sniffing position according to the Cormack–Lehane (p = 0.001) with a significantly lower difficulty in intubation according to the intubation difficulty scale (p = 0.008).Conclusion. The 25° backup position is better than the sniffing position in glottic visualization, the difficulty of intubation and the time of intubation. Age, gender, and body mass index have no significant effects on the visualization of the glottis between the 25° backup position and the sniffing position. There was no significant difference between two regarding the number of patients who needed ancillary manoeuvres and ancillary equipment. The glottic view is significantly better in the 25° backup position than sniffing position according to the Cormack–Lehane. The mean of the time of intubation is lower in the 25° backup position compared to the sniffing position.

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