Comparison of the Effect of Left Head Rotation versus the Direct Epiglottis Lifting Technique on Glottic View during C-MAC Videolaryngoscopy in Patients with Difficult Airway
Year: 2025
Type: article
Study designs: Randomized Controlled Trial, Clinical Trial
Abstract: BACKGROUND AND AIMS: Optimal glottic visualization is fundamental for safe intubation in patients with difficult airways. We aimed to compare the effectiveness of left head rotation (LeHeR) versus the direct epiglottis lifting technique using the C-MAC D-blade videolaryngoscope in improving glottic view during intubation in adult patients with difficult airways. METHODS: In this prospective, randomized, double-blinded trial, 60 adult patients were allocated equally to receive LeHeR (Group L) or direct epiglottis lifting (Group E) technique for intubation. After standardized induction, videolaryngoscopy with C-MAC D blade was done, and the best glottic view was captured. The second glottic image was taken following LeHeR in Group L and direct epiglottis lifting in Group E. Percentage of glottic opening (POGO) in both images was compared later by an anonymized anesthesiologist. Change in POGO, ease and time to intubation, hemodynamic responses, and desaturation < 95% were compared in both groups. RESULTS: Demographics and baseline airway variables were comparable. Both maneuvers significantly improved intragroup POGO scores ( P ≤ 0.001). The median second POGO was higher with epiglottis lifting than LeHeR technique (100 [interquartile range 75-100] vs. 75 [75-100], P = 0.03). Improvement in glottic view occurred in 96.7% of patients in Group E versus 63.3% in Group L ( P = 0.002). Time to intubation (33 ± 12 vs. 31 ± 10 s), ease of intubation, hemodynamics, and incidence of desaturation were comparable. CONCLUSION: Direct epiglottis lifting with C-MAC videolaryngoscope D blade provided significantly improved glottic visualization compared to LeHeR with comparable intubation time in patients with difficult airway.
Source: Annals of African Medicine
Authors: Maneesh Sheela Manikandan, Sunil Rajan, Fazil Haleel, Gayathri Sreekumar, Lokeshshiva Arul, Maharnab Bhuyan
Language: English
Subfield: Anesthesiology and Pain Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W4416792322