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Anesth Essays Res. 2019 Jul-Sep;13(3):535-538. doi: 10.4103/aer.AER_40_19.

Comparison of Laryngoscopic View Obtained by Conventional Head Rise to that Obtained by Horizontal Alignment of External Auditory Meatus and Sternal Notch.

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Department of Anaesthesiology Kalinga Institute of Medical Science, Bhubaneshwar, Orissa, India.
Department of Anaeshesiology, Sri Manakula Vinayagar Medical College and Hospital, Puducherry, India.
Department of Anaesthesiology, NSCB Medical College, Jabalpur, Madhya Pradesh, India.



The aim of this study was to determine the effect of change of patients' position during laryngoscopy on laryngoscopic view and to evaluate the effect of body mass index (BMI) and neck circumference on laryngoscopic view in both the positions.


A prospective, unblinded observational study was done with patients and laryngoscopists acting as their own controls. The study included 300 patients of ASA classes I and II aged more than 18 years who were scheduled to undergo general anesthesia. Detailed airway assessment including neck circumference and BMI of the patients was done. Initially, the patients were placed in the Head-Elevated Laryngoscopic Position (HELP) on the operating table. After proper intravenous induction, an experienced anesthesiologist did direct laryngoscopy with a suitable size Macintosh blade and assessed the C and L grades (HELP score). Immediately, the patients were repositioned to conventional sniff position and the C and L grades reassessed (sniff score). Both the scores were compared later on.


HELP provided a view better than or equal to sniff in 94% cases, whereas in only 6% of the cases, sniff provided a view better than HELP. HELP provided better view for laryngoscopy. Moreover, neck circumference as a parameter was more helpful in predicting difficult laryngoscopy compared to BMI.


HELP should be the ideal intubating position in all patients irrespective of ages and sexes with or without predilections for difficult airway.


Difficult intubation; head-elevated laryngoscopic position; intubation; laryngoscopy; sniff position

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