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LeHeR Maneuver vs Sniffing Position During Video Laryngoscopy in Predicted Difficult Airway
Sponsor: Sakarya University
Summary
The left head rotation (LeHeR) maneuver, in which the head of the supine patient is rotated 45° to the left, is a simple, equipment-free technique proposed to improve the laryngeal view. Studies using the Percentage of Glottic Opening (POGO) score during video laryngoscopy have reported improvement with LeHeR, but evidence is limited and the maneuver has not been systematically evaluated in patients with a predicted difficult airway. This prospective, observational, self-controlled study aims to compare the POGO score obtained in the sniffing position with that obtained in the 45° LeHeR position in the same adult patients with a modified El-Ganzouri Risk Index (EGRI) score above 4 undergoing elective surgery under general anesthesia with video laryngoscopy. Ease of intubation, number and duration of attempts, need for adjuvant maneuvers, hemodynamic changes, and airway trauma will also be recorded.
Official title: Comparison of Glottic View Between the Sniffing Position and the Left Head Rotation (LeHeR) Maneuver During Video Laryngoscopy in Patients With Predicted Difficult Airway: A Prospective, Observational, Self-Controlled Study
Key Details
Gender
All
Age Range
18 Years - 70 Years
Study Type
OBSERVATIONAL
Enrollment
40
Start Date
2026-12-01
Completion Date
2027-12-01
Last Updated
2026-10-29
Healthy Volunteers
No
Interventions
Video laryngoscopy in the sniffing position
After induction of general anesthesia and neuromuscular blockade (2 minutes), video laryngoscopy is performed with an appropriately sized video laryngoscope blade (e.g., C-MAC Macintosh or D-blade) with the head in the standard sniffing position. The best glottic view is graded using the Percentage of Glottic Opening (POGO) score. Patients with a POGO score of 100% are not studied further.
Left Head Rotation (LeHeR) maneuver
In patients with a POGO score below 100% in the sniffing position, the blade is withdrawn, propofol is titrated if needed to maintain anesthetic depth, the patient's head is rotated 45° to the left while supine, and video laryngoscopy is repeated. The glottic view is graded again using the POGO score and intubation is attempted in this position. If unsuccessful, routine difficult-airway maneuvers (BURP, external laryngeal manipulation, cuff inflation/deflation, bougie/stylet, return to the sniffing position) are used.