Comparison of Ease of Intubation and Laryngeal View Obtained Through Inflatable Pillow versus Manual Head Extension – A Randomised Prospective Study

Abstract Background: Endotracheal intubation is a crucial procedure in airway management. Achieving an optimal laryngeal view is essential for successful intubation. While manual head extension in the sniffing position is the conventional technique, an inflatable pillow offers an alternative approach that could standardize head positioning, reduce physical strain on the anesthesiologist, and improve glottic visualization. However, limited studies have compared these two techniques in terms of intubation ease and laryngeal view. Objectives: This study was aimed to compare the effectiveness of an inflatable pillow versus manual head extension in optimizing laryngeal visualization and ease of intubation. The primary parameters evaluated included the Cormack-Lehane (CL) grade, Intubation Difficulty Score (IDS), intubation success rates, and time to intubation. Methods: A total of 130 adult patients, aged 18-60 years, ASA grade I-II, scheduled for elective surgery requiring endotracheal intubation, were randomly assigned into two groups. Induction of anesthesia in both groups were done in supine position after preoxygenating with 100% oxygen for 3-5 minutes, then patients were premedicated with fentanyl (2 micrograms per kg) and midazolam (0.01mg/kg). After which patients received induction dose of propofol (2mg/kg over 30-40 seconds, with end point being loss of verbal contact with patient. Muscle Relaxation was achieved with Atracurium (0.5mg/kg).Group A underwent intubation with manual head extension, while Group B utilized an inflatable pillow to align the external auditory meatus with the sternal notch. Standard anesthesia protocols were followed. Intubation ease was assessed using the IDS, CL grade, and time to intubation. Statistical analysis was conducted using SPSS v22, with a p-value <0.05 considered significant. Results: Group B demonstrated a significantly shorter intubation time (30.53 ± 7.65 sec) compared to Group A (36.13 ± 12.25 sec, p=0.038). The head rise was significantly higher in Group B (13.30 ± 1.00 cm) than in Group A (10.00 ± 0.00 cm, p<0.001). CL grade and IDS were significantly better in Group B, indicating improved laryngeal visualization and easier intubation. Conclusion: The use of an inflatable pillow resulted in a better laryngeal view, reduced intubation difficulty, and shorter intubation time compared to manual head extension. This technique may be beneficial in clinical settings, particularly in patients where manual positioning is challenging. Further research is warranted to explore its applicability in diverse patient populations.