A COMPARISON OF RAMP POSITION AND SNIFFING POSITION DURING ENDOTRACHEAL INTUBATION BY JUNIOR RESIDENT (SECOND or THIRD YEAR) IN NON OBESE ADULTS UNDER GENERAL ANAESTHESIA

Comparison of sniffing position and ramp position for endotracheal intubation in adults posted for elective surgery by second or third year resident under general anaesthesia.

Objective is to compare the time for endotracheal tube insertion and time of vocal cord visualisation, the number of intubation attempts made, the laryngoscopic view will be graded according to the Cormack Lehane scale with and without cricoid pressure, any auxiliary methods used (change of laryngoscopist, bougie, change of device, stylet) and to observe pain score during the postoperative phase in the post-intubation area.

Inclusion criteria

Patients willing to sign written and informed consent, male or female patients between 18 to 65 years of age, patients belonging to American Society of Anaesthesiologists(ASA) physical status I and II, patients posted for elective surgeries under general anaesthesia.

Exclusion criteria

Patients unwilling to participate in study, patients with Body Mass Index more than 30 Kg per metre square, patients with unstable cervical spine, Patient with limited neck extension and flexion, Patient with large neck masses, Patients having arrythmias, Patients having heart rate less than 60 beats per minute, Psychiatric patients, Pregnancy and lactating women, Patients belonging to the American Society of Anaesthesiologists (ASA) III and above.

The study will be conducted  on adults aged between 18-65 years of either gender, belonging to ASA grade I & II, who will undergo elective surgeries under general anaesthesia. Patients will be divided into 2 equal

groups with computer generated block randomisation i.e. Group S will be in sniffing position during induction of anaesthesia. Group R will be in a Ramping position during induction of anaesthesia. After positioning laryngoscopy is performed and following things are to be observed and noted : Time of vocal cord visualisation (seconds), Time for endotracheal tube insertion (seconds), Number of intubation attempts made, Number of intubation attempts made, Cormack Lehane grade I or II a or II b or III or IV, Auxiliary method used (Bougie or Change of laryngoscopist either third year Resident or consultant or change of laryngoscope or Video laryngoscope or TAScope), Intubation done bySecond year Resident or Third year Resident or Consultant**.**Postoperatively observe pain score in the post-intubation area.

Site of Study: Department of Anaesthesiology, Dhiraj Hospital, S.B.K.S. Medical Institute and research

Centre, Piparia, Waghodia, Vadodara.

Study Design: Prospective, comparative, observational.

Study Duration: The study will be initiated after obtaining permission from institutional ethics committee till the achievement of sample size or by 6 months whichever is earlier.

Statistics: Data will be collected & tabulated. Numerical variables will be presented as mean & standard deviation (SD)

while categorical variables will be presented as frequency and percentage. As regard to numerical variables;

tests like unpaired student-t test and/or ANNOVA will be used wherever appropriate for between-groups

comparisons, while for categorical variables; chi-square test will be used. P value <0.05 will be considered

statistically significant.

Likely outcome: This comparative study will help us to differentiate between sniffing and ramping position by junior resident (second/third year) in non-obese adults under general anaesthesia and will enable us to know which among

the two positions for intubation is most beneficial in providing better stability to the patient.