Physiological and airway anatomical changes in the elderly challenges rapid securing the airway. Limited oxygen reserve, systemic and end organ comorbidities leads to increased morbidity and mortality during laryngoscopy and intubation in the elderly. Optimisation of the head and neck position improves laryngoscopic view and endotracheal intubation. The  sniffing position is forward flexion of cervical spine and head extension at the atlantooccipital joint aligns oropharyngeal and laryngeal axes. In the geriatric population, the glottis view is difficult due to restrictive changes at  atlantoaxial joint and cervical vertebrae mobility along with muscle tone and altered physiologic changes.  

Recent evidence suggests that positioning the patient prior to intubation with backup elevation compared to the classical sniffing position improves laryngeal inlet visualization. Therefore decreasing  time to intubation of the trachea thus preventing and minimizing the effects of hypoxia on the geriatric cerebral cognitive function along with prevention of myocardial ischemia. Similar studies has not explored the effectiveness of the backup position in the elderly population. This study proposes to compare the glottic opening views between supine and back up position in the same patient.