Yuki Akihisa1, Hiroshi Hoshijima2, Koichi Maruyama3, Yukihide Koyama4, Tomio Andoh5. 1. University Hospital Mizonokuchi, Teikyo University School of Medicine, Kawasaki 213-8507, Kanagawa, Japan. Electronic address: ypegtj25@yahoo.co.jp. 2. Division of Dento-Oral Anesthesiology, Tohoku University Graduate School of Dentistry, Sendai, 980-8575 Miyagi, Japan. Electronic address: hhoshi6@gmail.com. 3. University Hospital Mizonokuchi, Teikyo University School of Medicine, Kawasaki 213-8507, Kanagawa, Japan. Electronic address: maru555md@yahoo.co.jp. 4. Department of Anesthesiology and Critical Care Medicine, Yokohama City University Graduate School of Medicine, Yokohama 236-0004, Kanagawa, Japan. Electronic address: yukihidekoyama1008@gmail.com. 5. University Hospital Mizonokuchi, Teikyo University School of Medicine, Kawasaki 213-8507, Kanagawa, Japan. Electronic address: psdelico06@yahoo.co.jp.
Abstract
BACKGROUND: The purpose of this meta-analysis was to validate the efficacy of the sniffing position in the performance of intubation with direct laryngoscopy. METHODS: We searched MEDLINE, the Cochrane Central Register of Controlled Trials, Embase, and Web of Science. Six randomized controlled trials comprising 2759 adult participants were analyzed. The DerSimonian-Laird method was used to calculate pooled relative risk (RR) and the 95% confidence interval (CI) of Cormack-Lehane classification, Intubation Difficulty Scale, success rate of the first intubation, and weighted mean difference of intubation time. RESULTS: Compared with the other head positions, the sniffing position did not improve glottic visualization, success rate of the first intubation, or intubation time. However, the sniffing position was significantly associated with better Intubation Difficulty Scale compared with the simple head extension position. (RR,1.28; 95% CI, 1.15-1.42; p<0.0001) CONCLUSIONS: Although patients do not benefit from the sniffing position in terms of glottic visualization, success rate of the first intubation, or intubation time, the sniffing position can still be recommended as the initial head position for tracheal intubation because the sniffing position provides easier intubation conditions.
BACKGROUND: The purpose of this meta-analysis was to validate the efficacy of the sniffing position in the performance of intubation with direct laryngoscopy. METHODS: We searched MEDLINE, the Cochrane Central Register of Controlled Trials, Embase, and Web of Science. Six randomized controlled trials comprising 2759 adult participants were analyzed. The DerSimonian-Laird method was used to calculate pooled relative risk (RR) and the 95% confidence interval (CI) of Cormack-Lehane classification, Intubation Difficulty Scale, success rate of the first intubation, and weighted mean difference of intubation time. RESULTS: Compared with the other head positions, the sniffing position did not improve glottic visualization, success rate of the first intubation, or intubation time. However, the sniffing position was significantly associated with better Intubation Difficulty Scale compared with the simple head extension position. (RR,1.28; 95% CI, 1.15-1.42; p<0.0001) CONCLUSIONS: Although patients do not benefit from the sniffing position in terms of glottic visualization, success rate of the first intubation, or intubation time, the sniffing position can still be recommended as the initial head position for tracheal intubation because the sniffing position provides easier intubation conditions.
Authors: Matthew W Semler; David R Janz; Derek W Russell; Jonathan D Casey; Robert J Lentz; Aline N Zouk; Bennett P deBoisblanc; Jairo I Santanilla; Yasin A Khan; Aaron M Joffe; William S Stigler; Todd W Rice Journal: Chest Date: 2017-05-06 Impact factor: 9.410
Authors: J Adam Law; Laura V Duggan; Mathieu Asselin; Paul Baker; Edward Crosby; Andrew Downey; Orlando R Hung; Philip M Jones; François Lemay; Rudiger Noppens; Matteo Parotto; Roanne Preston; Nick Sowers; Kathryn Sparrow; Timothy P Turkstra; David T Wong; George Kovacs Journal: Can J Anaesth Date: 2021-06-18 Impact factor: 5.063