Preferred position?

hey folks!

Doing my weekly reading and came across an interesting article on airway positioning.

here it is !

Age and Gender Are Important Considerations in Choosing the Sniffing Position for Laryngoscopic View

That then lead me to find this article..

Airway management and patient positioning : a clinical perspective


And finally like all things I compare for airway, I go back to a great teacher..

Ear to sternal notch positioning


Take home points :

  1. Sniffing position is 3 elements – lower neck flexion, upper neck extension & atlanto-occipital joint extension
  2. “”Win with the chin” is a more useful aide memoire to good sniffing position for airway management
  3. The Ramped position or Ear to Sternal notch is superior for obese patients
  4. a 7cm hard head rest is used in most airway studies to provide “sniffing position” conditions. Dont think a soft pillow is good enough!
  5. Young males <50yo are more likely to benefit from the “sniffing position” vs females or those >50yo who may benefit more from ear to sternal notch position
  6. Face plane parallel to ceiling or tilted with atlanto-occipital extension ( sniffing position) will be optimal depending on the patient anatomy/habitus. Maximal chin extension will afford greater mouth opening/jaw movement but may make laryngeal visualisation with DL more difficult.
  7. Position is everything

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