Background: We explored whether positioning patients in a 25° back-up sniffing position improved glottic views
and ease of intubation.
Methods: In the first part of the study, patients were intubated in the standard supine sniffing position. In the
second part, the back of the operating table was raised 25° from the horizontal by flexion of the torso at the hips
while maintaining the sniffing position. The best view obtained during laryngoscopy was assessed using the
Cormack and Lehane classification and Percentage of Glottic Opening (POGO) score. The number of attempts at
both laryngoscopy and tracheal intubation, together with the use of ancillary equipment and manoeuvres were
recorded. The ease of intubation was indirectly assessed by recording the time interval between beginning of
laryngoscopy and insertion of the tracheal tube.
Results: Seven hundred eighty one unselected surgical patients scheduled for non-emergency surgery were
included. In the back-up position, ancillary laryngeal manoeuvres, which included cricoid pressure, backwards
upwards rightward pressure and external laryngeal manipulation, were required less frequently (19.6 % versus 24.
6 %, p = 0.004). The time from beginning of laryngoscopy to insertion of the tracheal tube was 14 % shorter
(median time 24 versus 28 s, p = 0.031) in the back-up position. There was no significant difference in glottic views.
Conclusions: The 25° back-up position improved the ease of intubation as judged by the need for fewer ancillary
manoeuvres and shorter time for intubation.
Trial registration: ClinicalTrials.gov Identifier: NCT02934347 registered retrospectively on 14th Oct 2016.
CORE (COnnecting REpositories)
CORE (COnnecting REpositories)