The optimal position for successful laryngoscopy and tracheal intubation is semi-fowler with flextension (commonly referred to as the "sniffing position") or Ramping
Key Principles:
1. Avoid supine position:
- This position can make alignment of airway structures more difficult and reduce the success rate of intubation.
2. Goal: To align the two airway curves:
- Primary curve: Oro-pharyngeal curve.
- Secondary curve: Pharyngo-glotto-tracheal curve.
Step 1
Flextension = Head lift+ Neck extension
i. Head lift (base of neck flexion) flattens the secondary curve.
ii. Neck extension (atlanto-occipital extension) flattens the primary curve.
iii. Combined head lift and neck extension = Flextension (sniffing position).
- Flattens both curve.
Step2
Ramping = Flextension + Semi-Fowler Position:
- Elevating the head of the bed to 30-45° while maintaining the sniffing position improves the alignment of airway structures, known as ramping.
- This position is especially effective in obese patients as it improves oxygenation and airway visualization.
Alternative for Patients with C-collar
- Reverse Trendelenburg Position:
- For patients with cervical spine precautions (C-collar in place), use reverse Trendelenburg (head elevated, feet lower) to optimize airway alignment and oxygenation without compromising spinal integrity.