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.
Study Type
OBSERVATIONAL
Enrollment
50
Change in Percentage of Glottic Opening (POGO) Score between Sniffing Position and Left Head Rotation
The Percentage of Glottic Opening (POGO) score will be assessed during video laryngoscopy in the sniffing position and after 45-degree left head rotation (LeHeR maneuver). The difference in POGO score between the two positions will be recorded for each participant.
Time frame: Baseline during induction of anaesthesia at the time of video laryngoscopy on Day 1 (single intra-operative assessment)
Time to Successful Intubation
Time taken from insertion of the video laryngoscope blade into the oral cavity until successful placement of the endotracheal tube confirmed by capnography.
Time frame: During induction of anesthesia on Day 1
Ease of Intubation
Ease of intubation assessed using Fremantle score as easy, modified, or unachievable based on number of attempts and need for adjuncts.
Time frame: During tracheal intubation on Day 1
Number of Intubation Attempts
Number of attempts required to achieve successful tracheal intubation.
Time frame: During tracheal intubation on Day 1
Requirement of Airway Adjuncts
Need for additional maneuvers such as external laryngeal manipulation, cuff inflation, or use of Magill forceps during intubation.
Time frame: During tracheal intubation on Day 1
Incidence of Peri-intubation Complications
Occurrence of complications such as oxygen desaturation (SpO₂ \<95%) or airway trauma during intubation.
Time frame: During induction of anesthesia and tracheal intubation on day 1
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