{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T08:59:20Z","timestamp":1790067560874,"version":"4.0.1"},"reference-count":20,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","license":[{"start":{"date-parts":[[2025,11,28]],"date-time":"2025-11-28T00:00:00Z","timestamp":1764288000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Aims:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>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 &lt; 95% were compared in both groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Demographics and baseline airway variables were comparable. Both maneuvers significantly improved intragroup POGO scores (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2264 0.001). The median second POGO was higher with epiglottis lifting than LeHeR technique (100 [interquartile range 75\u2013100] vs. 75 [75\u2013100],\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.03). Improvement in glottic view occurred in 96.7% of patients in Group E versus 63.3% in Group L (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.002). Time to intubation (33 \u00b1 12 vs. 31 \u00b1 10 s), ease of intubation, hemodynamics, and incidence of desaturation were comparable.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/aam.aam_462_25","type":"journal-article","created":{"date-parts":[[2025,11,28]],"date-time":"2025-11-28T14:00:44Z","timestamp":1764338444000},"page":"1589-1594","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["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"],"prefix":"10.4103","volume":"25","author":[{"given":"Maneesh Sheela","family":"Manikandan","sequence":"first","affiliation":[{"name":"Department of Anaesthesiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sunil","family":"Rajan","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fazil","family":"Haleel","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gayathri","family":"Sreekumar","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lokeshshiva","family":"Arul","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maharnab","family":"Bhuyan","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,11,28]]},"reference":[{"key":"R1-20260922","doi-asserted-by":"crossref","first-page":"289","DOI":"10.4103\/joacp.JOACP_254_19","article-title":"Optimal position for laryngoscopy \u2013 Time for individualization?","volume":"35","author":"Myatra","year":"2019","journal-title":"J Anaesthesiol Clin Pharmacol"},{"key":"R2-20260922","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1016\/j.jemermed.2020.05.008","article-title":"High-risk airway management in the emergency department. 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A review and update","volume":"16","author":"Levitan","year":"2000","journal-title":"Crit Care Clin"},{"key":"R18-20260922","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1186\/s12871-023-02259-x","article-title":"Direct versus indirect epiglottis elevation in cervical spine movement during videolaryngoscopic intubation under manual in-line stabilization: A randomized controlled trial","volume":"23","author":"Choi","year":"2023","journal-title":"BMC Anesthesiol"},{"key":"R19-20260922","doi-asserted-by":"crossref","first-page":"850","DOI":"10.4187\/respcare.03033","article-title":"Direct and indirect laryngoscopy: Equipment and techniques","volume":"59","author":"Collins","year":"2014","journal-title":"Respir Care"},{"key":"R20-20260922","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1186\/s12871-018-0663-9","article-title":"The evaluation of a better intubation strategy when only the epiglottis is visible: A randomized, cross-over mannequin study","volume":"19","author":"Hung","year":"2019","journal-title":"BMC Anesthesiol"}],"container-title":["Annals of African Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/aam.aam_462_25","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T08:00:21Z","timestamp":1790064021000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/aam.aam_462_25"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,28]]},"references-count":20,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.4103\/aam.aam_462_25","relation":{},"ISSN":["1596-3519","0975-5764"],"issn-type":[{"value":"1596-3519","type":"print"},{"value":"0975-5764","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,28]]},"assertion":[{"value":"2025-08-25","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-09-15","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}