Head elevation improves laryngeal exposure with direct laryngoscopy ☆ Mohammad I. El-Orbany MD (Professor of Anesthesiology) a,⁎ , Yohannes B. Getachew MD (Attending Pediatric Anesthesiologist) b,c , Ninos J. Joseph BS (Research Consultant) d ,

Study objective: The aim of this study was to examine the effect of changing head position on the laryngeal view in the same subject. Design: Prospective, randomized, crossover comparison of laryngeal views. Setting: Operating suite at a university-affiliated, community hospital. Patients: One hundred sixty-seven consenting adult patients scheduled to undergo elective surgery with general anesthesia. Interventions: After anesthesia induction and muscle relaxation and the head in extended position, the laryngeal view was graded in 3 different head height positions. A special inflatable pillow was placed under the subject's head before induction and was deflated to produce no head elevation or inflated to produce either 6.0 cm (sniffing position), or 10.0 cm elevation (elevated sniffing position) in random order. Mainresults:Theincidenceofdifficultlaryngoscopy(grade ≥3)was8.38%withnoheadelevation,2.39% inthesniffingposition,and1.19%intheelevatedsniffingposition.Headelevationwasnotassociatedwitha worse grade in any single patient.