The Impact of Patient Positioning on Video Laryngoscopy-Guided Tracheal Intubation in Obese Patients: A Prospective Observational Study Comparing Ramped versus Sniffing Position

Abstract Background: A successful tracheal intubation depends on the patient being positioned optimally, especially in obese patients who frequently have difficult airway anatomy. Hence, to identify the most practical and efficient method for managing airways, this study aimed to compare the ramped and sniffing postures during video laryngoscopy (VL)-guided tracheal intubation in obese individuals. Materials and Methods: A prospective observational study was conducted on 80 obese patients (body mass index > 30 kg/m 2 ) who were allocated to either the sniffing or ramped positions according to routine clinical practice. Total intubation time was the primary outcome, while endotracheal tube (ETT) insertion time, laryngoscopy time, and laryngoscopy view quality were secondary outcomes, along with intubation success rate. To identify significant differences between groups, statistical analysis was performed using data collected during intubation. Results: A fair comparison was ensured by a similar demographic profile of both groups. In comparison with the sniffing position, the ramped position significantly decreased total intubation time (25.74 ± 13.79 s vs. 42.51 ± 17.95 s; mean difference: −16.77 s, 95% confidence interval: −23.14 to −10.40 s, P = 0.001), as well as endotracheal tube insertion time ( P < 0.001). In the sniffing position, laryngoscopy time was slightly shorter ( P = 0.035). The improved Cormack–Lehane grade distribution in the ramped position was statistically significant ( P = 0.040). Conclusion: In obese patients at higher risk of rapid desaturation, the ramped position significantly shortens intubation time, which is clinically relevant, without sacrificing laryngeal visualization or success rates, thereby enhancing safety and efficiency during VL-guided tracheal intubation.