The Head and Neck Position for Endotracheal Intubation

Abstract

  While the sniffing position has traditionally been considered the standard head and neck position for laryngoscopy, recent evidence suggests that the sniffing position provides no significant advantage over simple head extension. At present, what is the optimal head and neck position for laryngoscopy and endotracheal intubation is controversial. Thus, we reconsider this topic as follows ; 1) the role of the head and neck position on obtaining a good glottic view during laryngoscopy based on the obstacle theory ; 2) the head and neck position and cervical spine motion ; 3) the most important segment of the cervical spine for obtaining a good laryngoscopic view-extension of the occipitoatlantoaxial (OAA) complex ; and 4) the head and neck position for establishing a greater OAA extension angle. In addition, we describe the problems and solutions of preoperative evaluation of the extension capacity of the OAA complex.