BACKGROUND: Several methods have been attempted to enhance the success rate of tracheal intubation using a lightwand. Some studies have reported that changing the shape of a lightwand and the position of the head during intubation could influence the intubation time or success rate. However, there are no reports concerning the head position of a patient on influencing the success rate during tracheal intubation using a lightwand. METHODS: We enrolled 109 ASA physical status I and II patients scheduled for elective surgery under general anesthesia. Patients were randomly allocated to the sniffing group (n = 52) or neutral group (n = 57), depending on the head position. A lightwand (Surch-Lite(TM), Bovie/Aaron Medical, St. Petersburg, USA) was bent at 9.5 cm from the distal tip with a 0 cm extrusion for both groups of patients (J shape). The head was elevated by approximately 8 cm in the sniffing group of patients and by approximately 2 cm in the neutral group of patients, with the face straight up maintained by placement of a pillow. RESULTS: The overall success rate at the first attempt was 98.1%. There were no differences in the mean intubation time between the two groups (sniffing group; 8.0 +/- 4.3 sec and neutral group; 9.3 +/- 4.1 sec). The mean intubation time tended to be longer in patients with modified Mallampati classification III than in patients with modified Mallampati classification I and II. CONCLUSIONS: This study has demonstrated that the use of a J shaped lightwand did not affect the intubation time, regardless of the head position. The intubation time appears to be related to the airway condition when using a lightwand for tracheal intubation.