Laryngoscopy Requires Less Force in the Extension-Extension Position

Alignment of the tracheal and oropharyngeal axes is considered to be fundamental to successful direct laryngoscopy. To achieve such alignment in patients without neck-mobility restrictions, the patient is placed in the “sniffing” position, with neck flexion and atlanto-occipital extension (e.g., by placing a pillow behind the head). These authors compared the lifting force required for laryngoscopy in the sniffing position and in the neck-extension/atlanto-occipital–extension position (e.g., by placing a pillow behind the shoulders).

Two experienced anesthesiologists used a modified Macintosh laryngoscope to measure the force along the axis of the handle during laryngoscopy in each position, in random order, in 20 patients undergoing general…