The effect of head position on glottic visulation and intubation success with videoyngoscope in obese patients

Patients who are planned to be operated under general anesthesia require intubation to ensure the maintenance of anesthesia. The glottis must be optimally visualized for successful intubation. Glottis visualization is evaluated by Cormack and Lehan grading (CL) and percentage of glottic opening (POGO) score. One of the most important step of optimum glottic visualization of glottis is positioning the head properly. Sniffing position, head extension position, neutral head position are well known and the most used head and neck positions. In this study, we aimed to examine the effect of head positions on glottic view quality and intubation success during laryngoscopy with a videoyngoscope (VL) in obese patients scheduled for operation. Intubation time in sniffing position was statistically significant shorter than neutral head position (p=0.001). There was no statistically significant difference between head extension position and other two head and neck positions in terms of intubation time. POGO score was statistically significantly higher in sniffing position than in neutral head position (p<0.001). There was no statistically significant difference between head extension position and other two head and neck positions in terms of POGO score. IDS score was statistically significantly higher in neutral head position compared to head extension position and sniffing position (p<0.001, p<0.001, respectively). In addition, IDS score in head extension position was statistically significantly higher than sniffing position (p=0.016). As a result, we found that the sniffing position of obese patients during VL improved glottic view compared to neutral position, shortened the duration of intubation, and decreased intubation difficulty. However, the sniffing position was not found to be superior to the head extension position except for difficulty in intubation. Therefore, we think that the sniffing position could be more appropriate compared to the neutral head and neck position in obese patients who are considered to be intubated with VL.