Your posture during intubation?

[Wertt]

Hi all,

I'm an MS4 doing an anesthesia elective and hoping to match next week. I have noticed some variation in posture of my staff and residents while intubating:

Some are bent down close to the pts face with the left elbow propped on the bed lifting with the biceps.

Others, and often older staff, are standing ram rod straight up, more looking down at the head, with their elbow tucked into their body and using a shift in body weight to lift the epiglottis.

I tend to fall into the stooped category, but twice now a staff has succeeded at an intubation that I had a grade zero view by using the more upright posture approach, so I wondered if folks here also feel this plays a big role in visualization success for DL? I'm thinking of trying to adopt this technique as it also seems less straining on the back and arm.

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[2ndyear]

I would start by raising the table so you're not stooping over. Try bringing the patients forehead to your xiphoid. And good luck in the match.

 

[anes]

Hi all,

I'm an MS4 doing an anesthesia elective and hoping to match next week. I have noticed some variation in posture of my staff and residents while intubating:

Some are bent down close to the pts face with the left elbow propped on the bed lifting with the biceps.

Others, and often older staff, are standing ram rod straight up, more looking down at the head, with their elbow tucked into their body and using a shift in body weight to lift the epiglottis.

I tend to fall into the stooped category, but twice now a staff has succeeded at an intubation that I had a grade zero view by using the more upright posture approach, so I wondered if folks here also feel this plays a big role in visualization success for DL? I'm thinking of trying to adopt this technique as it also seems less straining on the back and arm.

Look at the textbooks. They always show the anesthesiologist standing above, looking dow, back straight. When intubating somebody, picture what the textbook looks like and emulate that. Priceless advise that an attending once gave me.

 

[deleted59964]

not what you're asking but ... it sounds like you had a great view.

 

[Planktonmd]

You need to align your eyes with the axis from the lips to the trachea and the only way to do that is to bring the patient up to the level of your stomach and looking forward and down with your back straight.

 

[Mman]

Your posture doesn't influence your ability to intubate somebody. I mean really your head (and basically eyes) are the only thing that matters and you just have to be looking at the correct angle to see. It doesn't matter if you are standing up, sitting down, slouching, or are totally contorted.

That said, you look like an amateur when you are slouched over and trying to stick your head in the patient's mouth. Most experienced people will have fairly straight posture and just have the bed elevated to the height they need. It's easier on your own back to not slouch all the time.

 

[deleted126335]

I agree that it looks more professional to be standing up straight and further back from the patient. I just haven't been able to discern an advantage in effectiveness to being crouched and up close.

 

[Spinach Dip]

Your posture during intubation?


Me?

Generally flat on my back with my neck hyperextended, a bit of propofol dulling my nervous system.

 

[deleted171991]

My favorite posture is sitting comfortably upright at the patient's head (but not bent over in his face) , left arm semi-extended during masking and laryngoscopy, talking to the patient during induction, slightly backing away for good perspective view during laryngoscopy, everything within arm's reach, relaxed, chill, projecting control of the situation for the staff.

If one sits/stands in the right spot, there is almost no lifting necessary, besides swiping the tongue out of the way. Xyphoid height sounds about right. I always used to put the bed pretty high in residency, and didn't care if my attendings were surprised, and then I learnt (as an attending) that it's so much more comfortable and efficient to just sit. Same goes for IV placement.

The main lesson here is that anesthesia is like competitional figure skating: you will be judged not just on technical merit, but also on artistic impression. Like they have any idea WTF you're doing.

 

[deleted50478]

Hi all,

I'm an MS4 doing an anesthesia elective and hoping to match next week. I have noticed some variation in posture of my staff and residents while intubating:

Some are bent down close to the pts face with the left elbow propped on the bed lifting with the biceps.

Others, and often older staff, are standing ram rod straight up, more looking down at the head, with their elbow tucked into their body and using a shift in body weight to lift the epiglottis.

I tend to fall into the stooped category, but twice now a staff has succeeded at an intubation that I had a grade zero view by using the more upright posture approach, so I wondered if folks here also feel this plays a big role in visualization success for DL? I'm thinking of trying to adopt this technique as it also seems less straining on the back and arm.

 

[Wertt]

Yeah this is basically me. I blame the training laerdal sims that we learn on which sit on a table at my waist height.

 

[jwk]

Some are bent down close to the pts face with the left elbow propped on the bed lifting with the biceps.

If you're elbow is propped on the bed, it's not really possible to lift the laryngoscope blade - the tendency will be to rock back and snap off some upper incisors.

 

[lunaire]

I stand up straight. Bending over gives me lower back pain at the end of the day.

Another minor point is that you get better depth perception if you step back a bit and look at the vocal cord with both eyes, but this is easily correctable.

 

[fakin' the funk]

Your posture during intubation?
Me?

Generally flat on my back with my neck hyperextended, a bit of propofol dulling my nervous system.

Surely you meant to say "neck flexed on thorax 15-30 degrees, head extended on neck 90-120 degrees"