Difficult Airway, Obesity Difficult Airway Airway Management
Conditions
Brief summary
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.
Interventions
None listed
Sponsors
Royal Hospital, Oman
Study design
Observational model
CASE_CONTROL
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
Yes
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
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in Percentage of Glottic Opening (POGO) Score between Sniffing Position and Left Head Rotation | Baseline during induction of anaesthesia at the time of video laryngoscopy on Day 1 (single intra-operative assessment) | 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. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Time to Successful Intubation | During induction of anesthesia on Day 1 | Time taken from insertion of the video laryngoscope blade into the oral cavity until successful placement of the endotracheal tube confirmed by capnography. |
| Ease of Intubation | During tracheal intubation on Day 1 | Ease of intubation assessed using Fremantle score as easy, modified, or unachievable based on number of attempts and need for adjuncts. |
| Number of Intubation Attempts | During tracheal intubation on Day 1 | Number of attempts required to achieve successful tracheal intubation. |
| Requirement of Airway Adjuncts | During tracheal intubation on Day 1 | Need for additional maneuvers such as external laryngeal manipulation, cuff inflation, or use of Magill forceps during intubation. |
| Incidence of Peri-intubation Complications | During induction of anesthesia and tracheal intubation on day 1 | Occurrence of complications such as oxygen desaturation (SpO₂ \<95%) or airway trauma during intubation. |
Contacts
CONTACTKalesh Divakar, MD
CONTACTHarihar V Hegde, MD
Outcome results
None listed