Effect Of Left Head Rotation On Glottic View During Video Laryngoscopy In Obese Adults

Effect of Left Head Rotation Manoeuvre on Glottic View as Assessed With Percentage of Glottic Opening (POGO) Score During Video Laryngoscopy in Obese Adult Patients: A Prospective Observational Study

This study aims to evaluate whether the Left Head Rotation (LeHeR) maneuver improves visualization of the vocal cords during video laryngoscopy in obese adult patients undergoing general anesthesia. Obesity is associated with increased difficulty in airway management due to excess upper airway soft tissue and altered anatomy, which may impair visualization during intubation.

In this prospective observational study, 50 adult patients with a body mass index (BMI) ≥30 kg/m² will undergo video laryngoscopy using a C-MAC D-blade. The glottic view will be assessed using the Percentage of Glottic Opening (POGO) score in the standard sniffing position and after rotating the head 45 degrees to the left (LeHeR maneuver). A difference in POGO score between the two positions will be analyzed.

Secondary outcomes include ease of intubation, number of attempts, time to successful intubation, and occurrence of complications such as desaturation or airway trauma. The study is expected to determine whether the LeHeR maneuver is a simple and effective technique to improve airway visualization in obese patients.

Inclusion Criteria

• Adult patients aged 18-65 years
• Body mass index (BMI) ≥30 kg/m²
• ASA physical status I-III
• Scheduled for elective surgical procedures under general anesthesia requiring endotracheal intubation

Exclusion Criteria:

• Anticipated need for nasal intubation
• Facial or upper airway pathology preventing laryngoscope insertion
• Cervical spine instability or contraindication to head movement
• Pregnant patients