Effects of sniffing position for tracheal intubation: a meta-analysis of randomized controlled trials - 29/07/15

Doi : 10.1016/j.ajem.2015.06.049

Yuki Akihisa, MD ^a , Hiroshi Hoshijima, PhD ^b,^{^{1
Department of Anesthesiology, Saitama Medical University, 38 Morohongo, Irumagun Moroyamamachi, 350-0451 Saitama, Japan.}} , Koichi Maruyama, PhD ^a,^{^⁎} , Yukihide Koyama, PhD ^c,^{^{2
Department of Anesthesia, Fujisawa Shounandai Hospital, 2345 Takakura, Fujisawa 252-0802, Kanagawa, Japan.}} , Tomio Andoh, PhD ^a
^a University Hospital Mizonokuchi, Teikyo University School of Medicine, Kawasaki 213-8507, Kanagawa, Japan
^b Division of Dento-Oral Anesthesiology, Tohoku University Graduate School of Dentistry, Sendai, 980-8575 Miyagi, Japan
^c Department of Anesthesiology and Critical Care Medicine, Yokohama City University Graduate School of Medicine, Yokohama 236-0004, Kanagawa, Japan

^⁎Corresponding author. Department of Anesthesiology, University Hospital Mizonokuchi, Teikyo University School of Medicine, 3-8-3 Mizonokuchi, Takatsu-ku, Kawasaki 213-8507, Kanagawa, Japan. Tel.: +81 44 844 3333; fax: +81 44 844 0468.

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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.

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