Optimal head position for orotracheal intubation with a Tuoren videolaryngoscope in adult patients

Abstract Background and Aims: Optimal positioning of the head is advocated to facilitate intubation. However, the optimal head position for videolaryngoscopy-guided intubation is not known. This study aims to find out the optimal position for intubation with the Tuoren videolaryngoscope. Material and Methods: After obtaining Institutional Ethics Committee approval and written informed consent, 150 American Society of Anesthesiologists I–III adult patients with normal airway were enrolled and randomly allocated into three groups. Randomization was done using a computer-generated random number table. Group N patients were intubated in the neutral head position, group S in the sniffing position, and group head-elevated laryngoscopy position (HELP) patients in the head-elevated laryngoscopy position. General anesthesia was induced, and after complete muscle relaxation, the Tuoren videolaryngoscope was used for intubation. Ease of intubation (number of patients requiring maneuvers), glottic view, intubating conditions, laryngoscopy and intubation time, attempts, and intubation difficulty scale were recorded. Data were analyzed using SPSS v. 20.0, and P value < 0.05 was taken as significant. Results: Intubation was easiest in group S, where 42% of patients required maneuvers compared to 93% in group N and 79.5% in group HELP ( P < 0.001). The commonest maneuver used was rotation of the blade handle during laryngoscopy and external laryngeal manipulation. Glottic view was comparable among groups ( P = 0.215 for percentage of glottic opening score and P = 0.319 for Cormack Lehane grade). Laryngoscopy time ( P < 0.001), tracheal tube insertion time ( P = 0.043), ventilation time ( P = 0.0440), laryngoscopy attempt ( P = 0.005), intubation difficulty score ( P = 0.003), Laryngoscopy Difficulty Score ( P = 0.012), and difficulty degree ( P < 0.001) were significantly lower in group S compared to both groups N and HELP. Conclusions: Sniffing position was found to be the most optimal head position for orotracheal intubation with the Touren videolaryngoscope. Therefore, we recommend using the sniffing position while using this videolaryngoscope.