A Randomized Comparative Study of the Sniffing Position with Simple Head Extension for Visualization of Glottis and Difficulty in Intubation during Direct Laryngoscopy

Tracheal intubation remains one of the commonest means of establishing an airway. Alignment of laryngeal axis, pharyngeal axis, and oral axis during direct laryngoscopy causes line of vision for better visualization of glottis which is usually achieved in sniffing position. Simple head extension is also considered superior to sniffing position where significant number of patients intubated in the Sniffing position required more than one operator, external laryngeal manipulation, and use of increased force during laryngoscopy compared to those intubated through simple head extension. In this study we will determine the differences between the sniffing position and the simple head extension position with regard to the incidence of difficult mask ventilation and difficult laryngoscopy, difficult intubation, and variables of the IDS, time taken to intubate and the stance adopted by the anaesthesiologist performing laryngoscopy and tracheal intubation in adult patients undergoing elective surgery under general anaesthesia with muscle paralysis.