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

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.

Study Overview

• Status: Not yet recruiting
• Conditions: Difficult Airway; Obesity Difficult Airway Airway Management

• Study Type: Observational
• Enrollment (Estimated): 50

Contacts and Locations

• Study Contact: Name: Kalesh Divakar, MD; Phone Number: +968 92452839; Email: drkalesh@gmail.com
• Study Contact Backup: Name: Harihar V Hegde, MD; Phone Number: +968 98845606; Email: drharryhegde@yahoo.co.in

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

• Sampling Method: Non-Probability Sample

Study Population

Adult patients aged 18-65 years with body mass index (BMI) ≥30 kg/m², classified as ASA physical status II-III, undergoing elective surgical procedures under general anesthesia requiring orotracheal intubation at a tertiary care hospital.

Description

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

Study Plan

How is the study designed?

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
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.	Baseline during induction of anaesthesia at the time of video laryngoscopy on Day 1 (single intra-operative assessment)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
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.	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.	During tracheal intubation on Day 1
Number of Intubation Attempts	Number of attempts required to achieve successful tracheal intubation.	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.	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.	During induction of anesthesia and tracheal intubation on day 1

Collaborators and Investigators

• Sponsor: Royal Hospital, Oman

Study record dates

Study Major Dates

• Study Start (Estimated): May 1, 2026
• Primary Completion (Estimated): December 1, 2026
• Study Completion (Estimated): January 1, 2027

Study Registration Dates

• First Submitted: April 30, 2026
• First Submitted That Met QC Criteria: May 8, 2026
• First Posted (Actual): May 15, 2026

Study Record Updates

• Last Update Posted (Actual): May 15, 2026
• Last Update Submitted That Met QC Criteria: May 8, 2026
• Last Verified: May 1, 2026

More Information

Terms related to this study

• Other Study ID Numbers: MoH/CSR/26/31800

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Individual participant data will not be shared due to institutional policies and to ensure protection of participant confidentiality. Data may be made available upon reasonable request to the corresponding author, subject to institutional review and approval.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No