Modified Ramped Position: Is It the New Hope to Overcome Unanticipated Difficult Airway? A Comparative Study

Background: The prevalence of unanticipated difficult intubation is low but consistent making it a critical problem for anesthesiologists in an operating room. To overcome such life-threatening situations, we have attempted to estimate the benefits of the modified ramped position (MRP) over the classical morning sniffing position (MSP) in the general population. To achieve MRP, we have used the Hasanin pillow which was earlier tried for obese patients. Aim and Objectives: The aim of the study was to assess the usefulness of MRP for laryngoscopy and intubation compared to the traditional MSP. Methodology: One hundred and eighty-six patients belonging to the American Society of Anesthesiologists – PS I, II, and III scheduled for elective surgeries were enrolled. Group A patients (93) were placed in the MSP, whereas Group B (93) patients were placed in the MRP. Degree of difficulty with mask ventilation, Cormack–Lehane grading (CLG) on laryngoscopy, and intubation difficulty scale (IDS) score were assessed. Results: Demographic characteristics were comparable. Mask ventilation was easy for 79.6% participants in the MRP group compared to 63.4% of the MSP group ( P = 0.023). CLG view during laryngoscopy was easy for 68.8% (1, 2a grade) in MRP compared to 52.7% in MSP ( P = 0.014). Laryngoscopy and intubation were more difficult (IDS score > 5) with 4.3% in MSP compared to 3.2% in MRP ( P = 0.086). Conclusion: MRP provided better outcomes in terms of mask ventilation, laryngoscopic view, and ease of intubation with IDS compared to MSP. This could be important in clinical settings where rapid and effective airway management is crucial.