• Users Online: 404
  • Print this page
  • Email this page
Year : 2020  |  Volume : 3  |  Issue : 1  |  Page : 13-18

Patient positioning and glottic visualisation: A narrative review

1 Department of Anaesthesiology, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth Deemed-to-be University, Puducherry, India
2 Department of Anaesthesiology, Super Speciality Cancer Institute and Hospital, Lucknow, Uttar Pradesh, India
3 Department of Anaesthesiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India

Correspondence Address:
Dr. Nandhakumar Janani
Department of Anaesthesiology, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth Deemed-to-be University, Puducherry - 607 402
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ARWY.ARWY_3_20

Rights and Permissions

Optimal glottic view is a prerequisite for successful endotracheal intubation. Several factors such as height of pillow, head position, backup position and head-elevated laryngoscopy position (HELP) have been attributed to improve glottic view. This review of existing literature was conducted to summarise current evidence on the influence of different head positions on glottic view. The search engines used were PubMed, Cochrane Library, Google Scholar and ResearchGate. Keywords used for the search were sniffing position, HELP, backup position and glottic view. The two components of optimal sniffing position used traditionally for laryngoscopy include neck flexion of 35° and face-plane extension of 15° which is supposed to align three axes (oral, pharyngeal and laryngeal axes). Optimal height of pillow used to achieve sniffing position was found to be 9 cm. Since it is difficult to align all the three axes, the two-curve theory was proposed. Advantage of the sniffing position was questioned by various authors who projected the HELP and 25° backup position as better options. Our narrative review suggests that 25° backup and HELP position improves glottic view in comparison to supine sniffing position. To achieve alignment of external auditory meatus to the sternal notch, a small child required a small pillow, an older child or an adult required a bigger pillow and obese patients needed the ramped position/25° head-up position.

Print this article     Email this article
 Next article
 Previous article
 Table of Contents

 Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
 Citation Manager
 Access Statistics
 Reader Comments
 Email Alert *
 Add to My List *
 * Requires registration (Free)

 Article Access Statistics
    PDF Downloaded499    
    Comments [Add]    

Recommend this journal