Comparison of vocal cord view between neutral and sniffing position during orotracheal intubation using fiberoptic bronchoscope: a prospective, randomized cross over study

Sanghee Park, Hyung Gon Lee, Jeong Il Choi, Seongheon Lee, Eun-A Jang, Hong-Beom Bae, Jeeyun Rhee, Hyung Chae Yang, Seongtae Jeong, Sanghee Park, Hyung Gon Lee, Jeong Il Choi, Seongheon Lee, Eun-A Jang, Hong-Beom Bae, Jeeyun Rhee, Hyung Chae Yang, Seongtae Jeong

Abstract

Background: In intubation using fiberoptic bronchoscope (FOB), partial or complete obstruction of upper airway makes the FOB insertion difficult. Thus, maneuvers to relieve such obstructions are recommended. There have been no studies to determine whether the sniffing or neutral position is superior for this purpose. Therefore, this study was performed to examine the effects of these two positions including vocal cord view.

Methods: Fifty-four patients scheduled to receive general anesthesia by orotracheal intubation were eligible for inclusion in the study with informed consent. After confirmation of proper head positioning depending on the group, the view of the vocal cord was acquired in each position. Images were reviewed using the percentage of glottic opening (POGO) score.

Results: A total of 106 images of vocal cords from 53 patients were obtained. The mean of difference of POGO score was 11.09, higher for the neutral position and standard deviation was 23.73 (p = 0.002). Neutral position increased POGO score in 31 patients and decreased POGO score in 13 patients compare to sniffing position (p = 0.017). There were no significant differences between the two head positions with regard to intubation time or degree of convenience during intubation.

Conclusions: Neutral position improved the view of glottic opening than sniffing position during oral fiberoptic intubation. However, there was no difference in the difficulty of tube insertion between the two positions.

Trial registration: Clinical Trials.gov identifier: NCT02931019 , registered on October 12, 2016.

Keywords: Airway management; Fiberoptic bronchoscope; Intubation; Patient positioning.

Conflict of interest statement

Ethics approval and consent to participate

This study was approved by the Institutional Review Board of Chonnam National Universtiy Hwasoon Hospital (CNUHH-2016-120), and written informed consenst was obtained from all patients.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interest.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
CONSORT flowchart showing the flow of patients through the trial. Group NS: Neutral position followed by sniffing position, Group SN: Sniffing position followed by neutral position, FOB = fiberoptic bronchoscope
Fig. 2
Fig. 2
Comparison of the POGO (percentage of glottic opening) scores. A Solid line (—): Neutral position increased POGO score compare to Sniffing position (n = 31); a dot line (−-): decreased POGO score (n = 13); a grey line: no changes in POGO score (n = 9). The mean of difference of POGO score was 11.09, higher for the neutral position and standard deviation was 23.73 (p = 0.002). Neutral position significantly increased the number of patients with increased POGO score compare to sniffing position (p = 0.017)
Fig. 3
Fig. 3
Fiberoptic bronchoscopy views of vocal cord during (a) sniffing position and (b) neutral position

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