Trial reportKorean journal of anesthesiology2023
Ramped versus sniffing position in the videolaryngoscopy-guided tracheal intubation of morbidly obese patients: a prospective randomized study.
Trial report in Korean journal of anesthesiology, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
11 citing papers in PubMed, 1 synthesis or guideline pooled it, 23 citations in OpenAlex.
- Comparison of ramped and sniffing position for endotracheal intubation in obese patients: a systematic review and meta-analysis.Critical care science · 2026Pooled it
- Ramped versus sniffing position for Ambu® AuraGainTM insertion in patients with obesity: a randomized controlled study.Korean journal of anesthesiology · 2024Trial
- Airway management in critically ill patients with obesity.Intensive care medicine · 2026Review
- Ramped versus sniffing position for videolaryngoscopy-guided tracheal intubation in adult patients: A systematic review and meta-analysis with trial sequential analysis.Indian journal of anaesthesia · 2025Article
- Article
- Airway management and ventilation strategy among obese adult patients: a comprehensive review and analysis.Annals of medicine and surgery (2012) · 2025Article
- Obesity: a challenge for emergency medical teams-a narrative review.Frontiers in public health · 2025Review
- Screening and Perioperative Management of Obesity Hypoventilation Syndrome.Journal of clinical medicine · 2024Review
- Structured Routine Use of Styletubation for Oro-Tracheal Intubation in Obese Patients Undergoing Bariatric Surgeries-A Case Series Report.Healthcare (Basel, Switzerland) · 2024Article
- A Comparison of Miller Straight Blade and Macintosh Blade Laryngoscopes for Intubation in Morbidly Obese Patients.Journal of clinical medicine · 2024Article
- Bed-up-head-elevated Position versus Supine Sniffing Position in Patients Undergoing Rapid Sequence Intubation Using Direct Laryngoscopy in the Emergency Department - A Randomized Controlled Trial.Journal of emergencies, trauma, and shockArticle
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundRamped positioning is recommended for intubating obese patients undergoing direct laryngoscopy. However, whether the use of the ramped position can provide any benefit in videolaryngoscopy-guided intubation remains unclear. This study assessed intubation time using videolaryngoscopy in morbidly obese patients in the ramped versus sniffing positions.
methodsThis is a prospective randomized study in patients with morbid obesity (n = 82; body mass index [BMI] ≥ 35 kg/m2). Patients were randomly allocated to either the ramped or the standard sniffing position groups. During the induction of general anesthesia, difficulty in mask ventilation was assessed using the Warters scale. Tracheal intubation was performed using a C-MAC® D-Blade videolaryngoscope, and intubation difficulty was assessed using the intubation difficulty scale (IDS). The primary endpoint was the total intubation time calculated as the sum of the laryngoscopy and tube insertion times.
resultsThe percentage of difficult mask ventilation (Warters scale ≥ 4) was significantly lower in the ramped (n = 40) than in the sniffing group (n = 41) (2.5% vs. 34.1%, P < 0.001). The percentage of easy intubation (IDS = 0) was significantly higher in the ramped than in the sniffing group (70.0% vs. 7.3%, P < 0.001). The total intubation time was significantly shorter in the ramped than in the sniffing group (22.5 ± 6.2 vs. 40.9 ± 9.0, P < 0.001).
conclusionsCompared with the sniffing position, the ramped position reduced intubation time in morbidly obese patients and effectively facilitated both mask ventilation and tracheal intubation using videolaryngoscopy.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.