A COMPARATIVE STUDY OF EASE OF INTUBATION BETWEEN SNIFFING AND RAMP POSITION IN ELECTIVE INTUBATIONS: A RANDOMISED CONTROL TRIAL

Abstract

Background: Endotracheal intubation is a critical procedure performed during general anesthesia that requires optimal positioning to facilitate visualization of the glottis and successful tube placement. “Traditionally, the Sniffing position has been considered the gold standard for direct laryngoscopy. However, recent studies suggest that the Ramped position (RAMP) may offer advantages in certain patient populations. This randomized controlled trial aimed to compare the ease of intubation between the Sniffing and RAMP positions in patients undergoing elective surgeries requiring general anesthesia with endotracheal intubation.” Materials and Methods: One hundred and eight adult patients (ASA I-II) scheduled for elective surgeries under general anesthesia were randomly allocated to either the RAMP position (n=54) or the Sniffing position (n=54). The primary outcomes measured were laryngoscopic view (Cormack-Lehane grade), time to successful intubation, and number of intubation attempts. Secondary outcomes included hemodynamic responses (heart rate, blood pressure) to laryngoscopy and intubation, oxygen saturation, and complications. Data were analyzed using appropriate statistical tests with p<0.05 considered significant. Results: Demographic characteristics were comparable between the two groups. While there was no significant difference in Cormack-Lehane grading between the groups (p=0.692), the time to successful intubation was significantly shorter in the RAMP position (28.88 ± 8.36 seconds versus 32.22 ± 8.70 seconds, p=0.04). The first-attempt success rate was significantly higher in the RAMP position (92.6% versus 74.1%, p=0.02). Hemodynamic responses were significantly attenuated in the RAMP position, with lower post-laryngoscopy heart rate (p=0.009), systolic blood pressure (p=0.002), diastolic blood pressure (p=0.018), and mean arterial pressure (p=0.001) compared to the Sniffing position. These differences persisted until 5 minutes post-intubation. Fewer complications were observed in the RAMP position group (3.7% versus 22.2%, p=0.01), particularly sore throat (1.8% versus 16.7%). Oxygen saturation remained comparable between the groups throughout the study period xvi Conclusion: The RAMP position is associated with shorter intubation time, higher first-attempt success rate, attenuated hemodynamic responses to laryngoscopy and intubation, and fewer complications compared to the traditional Sniffing position in patients undergoing elective surgeries. These findings suggest that the RAMP position may be considered as a preferred positioning technique for routine endotracheal intubation in the elective setting.