By Dr. Harrison Whiting


Have you ever had difficulty trying to ventilate a patient with a BMV or been unable to visualise a patient’s vocal cords prior to intubation?

What are some manoeuvres that you can do to try and optimise your ability to ventilate a patient?


Sniffing Position

  • The sniffing position is achieved by flexion of the lower C spine + extension of the atlanto-occipital extension joint
  • This can be achieved by:
    • lining up the mastoid process with the sternal angle
    • raising the head of the bed
    • placing a pillow under neck to allow for flexion


How does putting a patient in the sniffing position make ventilation and observation of the vocal cords easier?

Airway Axes

There are 3 main airway axes. They are the Oral Axis (OA), the Pharyngeal Axis (PA), and the Laryngeal Axis (LA). At rest, these axes are not very well aligned and form almost a right angle. With soft tissue structures such as the tongue, this can make ventilation and first attempt intubation more difficult.

By placing a patient in the sniffing position, the airway axes are more aligned and allow for better visualisation and easier ventilation.

Patient not in the sniffing position

Patient placed in the sniffing position


For more information you can view the ABCs of Anaesthesia video on Optimal Patient Positioning for Intubation and Airway management at