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Reports of Original Investigations: Ichiro Takenaka, Kazuyoshi Aoyama, Tamao Iwagaki, Hiroshi Ishimura, and Tatsuo Kadoya 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] Can J Anesth 2007; 54: 129-133 [Abstract] [Full text] [PDF]

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The mechanism of the sniffing position

Leonard C Lee   (3 May 2007)

The mechanism of the sniffing position 3 May 2007
Leonard C Lee, Anaesthesia senior registrar Bunbury regional hospital Send letter to journal: Re: The mechanism of the sniffing position djlenny{at}gmail.com Leonard C Lee	This is an important study in elucidating the mechanism by which the sniffing position improves direct laryngoscopy. It supports the importance of occipito-atlanto-axial extension as the important determinant in the sniffing position. We have recently completed a clinical study comparing laryngoscopy forces in the sniffing position and the extension-extension position (occipito-atlanto-axial extension and also cervical vertebrae extension via the head section of the table broken and bent down)(Anaesthesia 2007 accepted for publication). Laryngoscopy force was significantly less in extension-extension compared to the sniffing position. This supports the concept that on a flat surface, occipito-atlanto-axial extension is actually impeded, and the sniffing position helps to overcome this. Similarly, a pillow behind the shoulders will also improve occipito- atlanto-axial extension.