This Article Résumé de cet Article Full Text Full Text (PDF) Submit a scholarly reply View responses Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Takenaka, I. Articles by Kadoya, T. Search for Related Content PubMed PubMed Citation Articles by Takenaka, I. Articles by Kadoya, T.

The sniffing position provides greater occipito-atlanto-axial angulation than simple head extension: a radiological study

[La position de reniflement fournit une meilleure angulation occipito-atlaïdoaxiale que la simple extension de la tête : une étude radiologique]

From the Department of Anesthesia, Nippon Steel Yawata Memorial Hospital, Kitakyushu, Japan.

Address correspondence to: Dr. Ichiro Takenaka, Department of Anesthesia, Nippon Steel Yawata Memorial Hospital, 1-1-1 Harunomachi, Yahatahigashi-ku, Kitakyushu 805-8508, Japan. Phone: 81-93-671-9420; Fax: 81-93-671-9605; E-mail: takenaka.i{at}ns.yawata-mhp.or.jp

Purpose: While the anatomic sniffing position has traditionally been considered the standard head and neck position for laryngoscopy, recent evidence suggests that the sniffing position provides no significant advantage over simple head extension. To establish if the sniffing position provides an anatomic advantage, we compared the occipito-atlanto-axial extension angle, a key determinant for obtaining a good laryngeal view during laryngoscopy, in simple head extension and sniffing positions.

Methods: Thirty volunteers with normal cervical spines were studied. Radiological examinations of the lateral cervical spine were taken and compared in each of the following three positions for each subject: neutral position (flat on the table with no pillow and without head extension or flexion); simple head extension (head maximally extended without a pillow); and the sniffing position (head extension with cervical flexion obtained by 7 cm occipital elevation).

Results: Mean angles of the occipito-atlanto-axial extension in simple head extension and the sniffing position were 20.4°± 5.1° and 24.2°± 5.6°, respectively (P < 0.01).

Conclusion: The anatomic sniffing position provides greater occipito-atlanto-axial extension compared to simple head extension. These findings should be taken into consideration when optimizing patient positioning for laryngoscopy.

eLetters: