• Hyerim Kim, Jee-Eun Chang, Dongwook Won, Jung-Man Lee, Tae Kyong Kim, Min Jong Kim, Seong-Won Min, and Jin-Young Hwang.
• From the Department of Anesthesiology and Pain Medicine, SMG-SNU Boramae Medical Center, Department of Anesthesiology & Pain Medicine, College of Medicine, Seoul National University (HK, J-EC, DW, J-ML, TKK, S-WM, J-YH), and the Department of Anesthesiology & Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea (MJK).
• Eur J Anaesthesiol. 2023 Aug 1; 40 (8): 560567560-567.

BackgroundDifferent head and neck positions may affect video laryngoscopy in terms of laryngeal exposure, intubation difficulty, advancement of the tracheal tube into the glottis and the occurrence of palatopharyngeal mucosal injury.ObjectiveWe investigated the effects of simple head extension, head elevation without head extension and the sniffing position on tracheal intubation using a McGRATH MAC video laryngoscope.DesignA randomised, prospective study.SettingMedical centre governed by a university tertiary hospital.PatientsA total of 174 patients undergoing general anaesthesia.MethodsPatients were randomly allocated to one of three groups: simple head extension (neck extension without a pillow), head elevation only (head elevation with a pillow of 7 cm and no neck extension) and sniffing position (head elevation with a pillow of 7 cm and neck extension).Main OutcomesDuring tracheal intubation using a McGRATH MAC video laryngoscope in three different head and neck positions, we assessed intubation difficulty by several methods: a modified intubation difficulty scale score, time taken for tracheal intubation, glottic opening, number of intubation attempts, requirements for other manoeuvres (lifting force or laryngeal pressure) for laryngeal exposure and advancement of the tracheal tube into the glottis. The occurrence of palatopharyngeal mucosal injury was evaluated after tracheal intubation.ResultsTracheal intubation was significantly easier in the head elevation group than in the simple head extension ( P  = 0.001) and sniffing positions ( P  = 0.011). Intubation difficulty did not differ significantly between the simple head extension and sniffing positions ( P  = 0.252). The time taken for intubation in the head elevation group was significantly shorter than that in the simple head extension group ( P  < 0.001). A lifting force or laryngeal pressure was required less frequently for tube advancement into the glottis in the head elevation group than in the simple head extension ( P  = 0.002) and sniffing position groups ( P  = 0.012). The need for a lifting force or laryngeal pressure for tube advancement into the glottis was not significantly different between the simple head extension and sniffing positions ( P  = 0.498). Palatopharyngeal mucosal injury occurred less frequently in the head elevation group than in the simple head extension group ( P  = 0.009).ConclusionThe head elevation position facilitated tracheal intubation using a McGRATH MAC video laryngoscope compared with a simple head extension or sniffing position.Trial Registry NumberClinicalTrials.gov (NCT05128968).Copyright © 2023 European Society of Anaesthesiology and Intensive Care. Unauthorized reproduction of this article is prohibited.

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