Clinical Research Directory
Browse clinical research sites, groups, and studies.
Sniffing Position vs Left Head Rotation (LeHeR) Maneuver for Glottic View During Direct Laryngoscopy
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 laryngeal view during laryngoscopy. Published results are conflicting: self-controlled studies report improvement, whereas parallel-group and large cohort studies do not. This prospective, observational, self-controlled study aims to compare the glottic view obtained in the standard sniffing position with that obtained in the 45° LeHeR position in the same adult patients undergoing elective surgery under general anesthesia with direct laryngoscopy. Glottic view will be graded with the modified Cormack-Lehane classification and the Percentage of Glottic Opening (POGO) score. Intubation difficulty, need for additional maneuvers or adjuncts, 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 Direct Laryngoscopy: A Prospective, Observational, Self-Controlled Study
Key Details
Gender
All
Age Range
18 Years - 70 Years
Study Type
OBSERVATIONAL
Enrollment
150
Start Date
2026-12-01
Completion Date
2027-12-01
Last Updated
2026-10-29
Healthy Volunteers
No
Interventions
Direct laryngoscopy in the sniffing position
After induction of general anesthesia and adequate neuromuscular blockade (3 minutes), direct laryngoscopy is performed with an appropriately sized Macintosh blade with the patient's head in the standard sniffing position. The best glottic view is graded using the modified Cormack-Lehane classification and the Percentage of Glottic Opening (POGO) score. Patients with a Cormack-Lehane grade 1 view are not studied further
Left Head Rotation (LeHeR) maneuver
In patients with a Cormack-Lehane grade 2A-4 view in the sniffing position, the laryngoscope is withdrawn, the patient's head is rotated 45° to the left while supine, and direct laryngoscopy is repeated with the same Macintosh blade. The glottic view is graded again using the modified Cormack-Lehane classification and the POGO score, and endotracheal intubation is attempted in this position. If unsuccessful, standard rescue maneuvers (BURP, external laryngeal manipulation, return to the sniffing position) and adjuncts (bougie/stylet) are used per routine practice.