Volume 6, No. 2 • Summer 1991

Head Position Key to Ease of Intubation

Michael Popitz, M.D

To the Editor

Management of the airway is, upon occasion, fraught with difficulties which can lead to increased patient morbidity and mortality Aside from the worst case scenarios of inability to ventilate or unrecognized esaphageal intubations, them is airway trauma (injury to teeth, cords, naso-oro-pharynx); the CNS and myocardial stress of catecholamine release; and face mask neuro-vascular pressure problem. A new type of head support device is now available which can help the anesthetist avoid some of these airway management difficulties, and thus improve patient care and safety.

There have been many head support cushions available to the anesthetist in the past. However, until now none have been able to align and maintain the alignment of the oro-laryngo-tracheal axis, with or without complete muscle relaxation, with comfort for the awake patient and incorporating a pressure point avoidance surface. The new device places the head of the patient in the sniffing position and maintain an optimal airway for the sedated patient. In addition, it makes ventilation of a patient by mask easier, assists in providing a clear view of the cords when the tongue is moved to the side with a laryngoscope blade, and requires at most only a centimeter of lift for complete view of the cords. I find that the majority of “difficult” and emergency intubations become comparatively easy with this device, which allows a complete view of the anatomy of the Larynx from above. If we can help to avoid the unnecessary morbidity and mortality associated with airway management with use of it, it should be made available to all anesthesia providers.

Michael Popitz, M.D. Brigham and Women’s Hospital, Boston