• Journal: Anesthesia & Analgesia

• PMID: 31348051

• Type of study: Randomized, controlled, single-blinded

• Hypothesis: The bed-up-head-elevated (BUHE) intubation position is noninferior to Glidescope (GLSC)-assisted intubation with regard to laryngeal exposure.

• Methods: University Malaya Medical Centre, ASA I-III, age 18-75 years

  • Exclusion Criteria

    1. Ischemic heart disease

    2. BMI >35 kg/M2

    3. RSI induction

    4. Small mouth opening

    5. Contraindication to neck extension

  • Protocol

    1. All patients in supine in sniffing position with head ring

    2. Baseline laryngoscopy w/ MAC 3 or 4 blade by 1 of 2 investigators who were blinded to treatment arm. Laryngeal exposure quantified

    3. Patients then positioned according to allocation group

    4. BUHE position with MAC 3 or 4 blade

    5. GLSC in supine position (removing head ring)

    6. Single, blinded investigator performed all intubations after final positioning

• Results: No difference in glottic visualization in BUHE vs. GLSC groups, BUHE intubation 8 seconds faster

  • Strengths:

    1. Randomized, controlled trial

    2. Statistical analysis- corrected p value for multiple primary outcomes

    3. Equivalent baseline POGO score

    4. Used standardized protocol

    5. Limited # of intubators

    6. Evaluated multiple relevant variable

  • Weaknesses:

    1. Exclusions

    2. Obese patients

    3. Those with difficult airway predictors

    4. Single center

    5. Intubators were un-blinded

    6. Removal of head ring in VAL group

    7. Limited # of intubators

    8. Restricted to OR intubations

• Key Point: The BUHE intubating position provides equivalent glottic views as use of a Glidescope.

Anesth Analg. 2020 Jul;131(1):210-219