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

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.

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Key information

Conditions

Difficult Airway Obesity Difficult Airway Airway Management

Age range

18 year–65 year

Sex eligibility

All sexes

Study type

Observational

Who can participate

Healthy volunteers accepted: Yes

Only the study team can determine whether someone qualifies for participation.

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

Treatment and study plan

Primary outcomes

Change in Percentage of Glottic Opening (POGO) Score between Sniffing Position and Left Head Rotation

Time frame: 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 outcomes

Time to Successful Intubation

Time frame: 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

Time frame: 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

Time frame: During tracheal intubation on Day 1

Number of attempts required to achieve successful tracheal intubation.
Requirement of Airway Adjuncts

Time frame: 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

Time frame: During induction of anesthesia and tracheal intubation on day 1

Occurrence of complications such as oxygen desaturation (SpO₂ <95%) or airway trauma during intubation.

Study contacts

Contact information is provided by the study sponsor or research team.

Harihar V Hegde, MD

CONTACT

[email protected]

+968 98845606

Kalesh Divakar, MD

CONTACT

[email protected]

+968 92452839

Sponsors and collaborators

Lead sponsor

Royal Hospital, Oman

Other Gov

Registry information

Official study title

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

Acronym: LeHeR

Important dates

Study start: 2026
Primary completion: 2026
Study completion: 2027
First posted: May 15, 2026
Registry last updated: May 15, 2026

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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