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Comparison of the Glottic Views in a Head Elevated Laryngoscopy Position with the Patient in Supine or 25º Backup: An
Janani Nandhakumar1, Hemanth Kumar Vadlamudi Reddy1, Indubala Maurya2
1Department of Anesthesiology and Critical Care, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth, Pondicherry, India.
Background:
Simple manoeuvres such as Head elevated laryngoscopy position (HELP) can facilitate a better glottic view. We conducted this prospective randomized clinical trial to compare the glottic view in a head elevated laryngoscopy position with the same patient in supine and 25° backup position.
Methods:
A total of 180 patients aged between 18-65 years, planned for elective surgery under general anaesthesia with endotracheal intubation using Macintosh laryngoscope were included. Any patient with anticipated airway difficulty, emergency surgeries or rapid sequence induction was excluded. All patients were randomized into two groups (Group B=90, Group S= 90). In group S, the glottic view was assessed while the patients were in 25° back up HELP position (1st position). Then the patients were repositioned and intubated in supine HELP (2nd position) position after reassessing the glottic view. In group B, the glottic view was assessed while the patients were in the supine HELP position (1st position). Then the patients were repositioned and intubated in 25° backup HELP position (2nd position) after reassessing the glottic view. Percentage of glottis opening score (POGO), Cormack Lehane (CL) Grade, laryngoscopy time, intubation time, attempts for intubation, anaesthesiologists comfort, use of ancillary devices/ manoeuvres and ease of intubation were recorded.
Results:
The mean POGO score was significantly more in 25° backup than supine position (n=180; 25° backup HELP: 64.78 ±26.83 % vs Supine HELP: 46.96±27.71 %, p- value< 0.0001). The Cormack Lehane grade was significantly higher in the supine HELP position than 25° backup HELP position (n=180, p-value<0.0001). The mean laryngoscopy time was comparable between two positions (n=180, Supine with HELP: 9.38±3.80 sec, 25° backup with HELP: 9.47±3.80 sec; p-value: 0.608). The mean intubation time was significantly shorter (p-value: 0.001) in Group B (7.7±2.2 seconds) than Group S (9.2± 3.6 seconds).
Conclusions:
This study has shown that 25° backup HELP position provides improved glottic view in comparison to the supine HELP position.
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