{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T16:42:21Z","timestamp":1786725741554,"version":"build-2736575974"},"reference-count":14,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"12","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2023,12]]},"abstract":"\n Background and Aims:<\/jats:title>\n The 25\u00b0back-up position is proposed to increase the efficacy of preoxygenation and provide better tracheal intubating conditions when using a direct laryngoscope. This study aimed to compare the ease of tracheal intubation between supine and 25\u00b0 back-up positions when using two video laryngoscopes (VLS).<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n \n One hundred adults with normal airways and belonging to the American Society of Anesthesiologists physical status classes I and II, requiring general anaesthesia, were randomised in groups K and M. The trachea was intubated using King Vision and McGrath VLS in either supine (groups K1 and M1) or 25\u00b0 back-up (groups K2 and M2) positions. The 25\u00b0 backup position was given by raising the operating table from the horizontal position by flexing the torso at the hips so that an imaginary line connected the patient\u2019s external auditory meatus to the sternal notch. Modified Intubation Difficulty Scale (mIDS) was the primary outcome, and intubation time, the number of intubation attempts, vital parameters, and complications were compared secondarily. Statistical analysis was done using MedCalc software by applying an independent\n t<\/jats:italic>\n -test for parametric data and a Chi-square test for categorical data and finding the risk ratio.\n <\/jats:p>\n <\/jats:sec>\n \n Result:<\/jats:title>\n \n Mean (Standard deviation) mIDS was significantly reduced using both VLS in the 25\u00b0 back-up position [0.92 (0.75) versus 0.48 (0.58),\n P<\/jats:italic>\n = 0.025, degree of freedom (DF): 48, mean difference (95% confidence interval [CI]):\u22120.44 (\u22120.821 to \u2212 0.059) in group K1 versus group K2 and 0.76 (0.59) versus 0.36 (0.48),\n P<\/jats:italic>\n = 0.012, DF: 48, mean difference (95% CI): \u22120.40(\u22120.706 to \u2212 0.094) in group M1 versus group M2, respectively]. The risk ratio comparing both the positions for the total number of patients requiring manoeuvres during intubation using both the VLS was 0.48 with\n P<\/jats:italic>\n = 0.0004 and 95% CI = 0.305 \u2212 0.765. Intubation time was shorter in the 25\u00b0 backup position by using King Vision\n (P<\/jats:italic>\n = 0.005) and McGrath\n (P<\/jats:italic>\n = 0.042) VLS.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion:<\/jats:title>\n The 25\u00b0 backup position helps provide ease of intubation using both the channelled (King Vision) and non-channelled (McGrath) VLS.<\/jats:p>\n <\/jats:sec>","DOI":"10.4103\/ija.ija_662_23","type":"journal-article","created":{"date-parts":[[2023,12,15]],"date-time":"2023-12-15T09:01:22Z","timestamp":1702630882000},"page":"1090-1095","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":2,"title":["Comparison of intubating conditions in supine (sniffing) and 25\u00b0 back-up position using channelled and non-channelled video laryngoscopes - A randomised controlled study"],"prefix":"10.4103","volume":"67","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6081-2751","authenticated-orcid":false,"given":"Devyani","family":"Desai","sequence":"first","affiliation":[{"name":"Department of Anaesthesiology, Baroda Medical College, Vadodara, Gujarat, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Riddhi","family":"Sompura","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Baroda Medical College, Vadodara, Gujarat, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sudarshan","family":"Yadav","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Baroda Medical College, Vadodara, Gujarat, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2023,12,13]]},"reference":[{"key":"R1-20260508","doi-asserted-by":"crossref","first-page":"169","DOI":"10.4103\/ija.ija_234_22","article-title":"Video laryngoscopy for all intubations: Is direct laryngoscopy obsolete?","volume":"66","author":"Myatra","year":"2022","journal-title":"Indian J Anaesth"},{"key":"R2-20260508","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1213\/ANE.0b013e31821c7e9c","article-title":"Head and neck position for direct laryngoscopy","volume":"113","author":"El-Orbany","year":"2011","journal-title":"Anesth Analg"},{"key":"R3-20260508","doi-asserted-by":"crossref","first-page":"847","DOI":"10.1111\/anae.14289","article-title":"A randomised clinical trial comparing the \u2018sniffing\u2019 and neutral position using channelled (KingVision\u00ae) and non-channelled (C-MAC\u00ae) video laryngoscopes","volume":"73","author":"Mendonca","year":"2018","journal-title":"Anaesthesia"},{"key":"R4-20260508","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1186\/s12871-016-0280-4","article-title":"Comparison of glottic views and supine and 25-degree backup positions and intubation times","volume":"16","author":"Reddy","year":"2016","journal-title":"BMC Anesthesiol"},{"key":"R5-20260508","doi-asserted-by":"crossref","first-page":"312","DOI":"10.4103\/joacp.JOACP_35_19","article-title":"Comparative evaluation of laryngeal view and intubating conditions in two laryngoscopy positions-attained by conventional 7 cm head raise and that attained by horizontal alignment of external auditory meatus-sternal notch line using an inflatable pillow-A prospective randomised cross-over trial","volume":"35","author":"Pachisia","year":"2019","journal-title":"J Anaesthesiol Clin Pharmacol"},{"key":"R6-20260508","doi-asserted-by":"crossref","first-page":"e029761","DOI":"10.1136\/bmjopen-2019-029761","article-title":"Investigator-initiated, multicentre, open-label, two-arm, randomised controlled trial comparing intubating conditions in 25\u00b0 head-up position and supine: The InSize25 study protocol","volume":"9","author":"Falempin","year":"2019","journal-title":"BMJ Open"},{"key":"R7-20260508","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1093\/bja\/aem095","article-title":"Laryngeal exposure during laryngoscopy is better in the 25-degree back-up position than in the supine position","volume":"99","author":"Lee","year":"2007","journal-title":"Br J Anaesth"},{"key":"R8-20260508","first-page":"210","article-title":"Comparison of Macintosh laryngoscopy in bed-up-head-elevated position with Glide Scopelaryngoscopy: A randomised, controlled, non inferiority trial","volume":"28","author":"Tsan","year":"2020","journal-title":"AnesthAnalg"},{"key":"R9-20260508","doi-asserted-by":"crossref","first-page":"174","DOI":"10.15441\/ceem.15.048","article-title":"Effects of an elevated position on time to tracheal intubation by novice intubators using Macintosh laryngoscopy or video laryngoscopy: Randomized crossover trial","volume":"2","author":"Wai","year":"2015","journal-title":"Clin Exp Emerg Med"},{"key":"R10-20260508","doi-asserted-by":"crossref","first-page":"667","DOI":"10.1016\/j.bjan.2020.08.009","article-title":"A comparison of ramping and sniffing positions during endotracheal intubation: A systematic review and meta-analysis","volume":"70","author":"Tsan","year":"2020","journal-title":"Rev Bras Anestesiol"},{"key":"R11-20260508","doi-asserted-by":"crossref","first-page":"342","DOI":"10.4103\/joacp.JOACP_100_16","article-title":"Comparison of ease of intubation in sniffing position and further neck flexion","volume":"33","author":"Gudivada","year":"2017","journal-title":"J Anaesthesiol Clin Pharmacol"},{"key":"R12-20260508","doi-asserted-by":"crossref","first-page":"668","DOI":"10.1213\/01.ane.0000492910.24950.30","article-title":"Prospective randomized comparative study of direct laryngoscopic view in sniffing and 25-degree backup position","volume":"123","author":"Agaskar","year":"2016","journal-title":"Anesth Analg"},{"key":"R13-20260508","first-page":"170","article-title":"Comparison of mean time to endotracheal intubation with 25\u00b0back-up position with horizontal supine sniffing position in patients undergoing elective surgery","volume":"16","author":"Farukh","year":"2020","journal-title":"IJSRM Human"},{"key":"R14-20260508","doi-asserted-by":"crossref","first-page":"986","DOI":"10.1016\/j.ajem.2017.02.011","article-title":"Feasibility of upright patient positioning and intubation success rates at two academic emergency departments","volume":"35","author":"Turner","year":"2017","journal-title":"Am J Emerg Med"}],"container-title":["Indian Journal of 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