Dynamic optimisation of the sniff position during laryngoscopy using a pressure infusion bag

摘要

Isono et al.'s [1] recent article on airway research emphasised controversies surrounding Sellick's manoeuvre, poor pre-marketing trials of new airway devices and airway obstruction in recovery, but did not address those relating to the 'sniff position at laryngoscopy and tracheal intubation. Although Adnet et al. have challenged this position using imaging and clinical studies [2-4], it remains generally accepted as providing the best chance of adequate laryngeal exposure [5]. Unfortunately, the sniff position cannot be achieved in all patients using a pillow or a head ring of a fixed height. We have developed an inflatable, cushioned ring that allows for adjustable head height and therefore optimal sniff position (Fig. 2). With approval from the hospital ethics committee and the written consent of participants, we carried out a pilot study of 24 ASA 1-2 patients undergoing laryngoscopy and tracheal intubation for elective surgical procedures. An uninflated one-litre pressure infusion bag was placed between the occiput and the atlanto-occipital joint.