{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,2]],"date-time":"2026-08-02T19:47:48Z","timestamp":1785700068044,"version":"3.56.0"},"reference-count":0,"publisher":"Ovid Technologies (Wolters Kluwer Health)","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"Abstract<\/jats:title>\n \n Background:<\/jats:title>\n Achieving an optimal glottic view is critical in pediatric anesthesia to prevent hypoxia and bradycardia. The \u201cLeft Head Rotation\u201d (LeHeR) maneuver has been proposed as a simple technique to improve laryngeal exposure. This study evaluated the impact of 45\u00b0 LeHeR on Cormack\u2013Lehane (CL) grading in pediatric patients compared to the classic sniffing position.<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n We conducted a prospective and observational study of 40 ASA I-II patients (aged 5\u201314 years) undergoing elective surgery. Following standardized induction, direct laryngoscopy was performed in the sniffing position using Macintosh laryngoscope. Patients with CL Grade II\u2013IV were included. The head was then rotated 45\u00b0 to the left and the glottic view was re-assessed. The primary outcome was improvement in CL grade. The secondary outcomes included ease of intubation, hemodynamic stability, and oxygen saturation (SpO2).<\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n \n Improvement in CL grade was observed in 80% (\n n<\/jats:italic>\n = 32) of patients upon rotating the head to the left (\n P<\/jats:italic>\n < 0.001). Distribution shifted significantly from predominantly CL III (\n n<\/jats:italic>\n = 29) in the sniffing position to CL II (\n n<\/jats:italic>\n = 28) in the LeHeR position. The mean time to intubate was 32.08 \u00b1 11.52 s, with a 92.5% first-attempt success rate. Hemodynamics and SpO2 remained stable throughout the procedure.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion:<\/jats:title>\n The LeHeR maneuver significantly improves glottic visualization in pediatric patients with initially poor views, providing a safe and effective alternative for difficult airway management.<\/jats:p>\n <\/jats:sec>","DOI":"10.4103\/aam.aam_691_26","type":"journal-article","created":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T07:00:13Z","timestamp":1784185213000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Effect of Left Head Rotation Maneuver on Glottic View in Pediatric Patients during Direct Laryngoscopy: A Prospective, Observational Study"],"prefix":"10.4103","author":[{"given":"Sunil","family":"Rajan","sequence":"first","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":"Kajol Nilesh","family":"Amin","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aishwarya","family":"Prasad","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aparna","family":"Chandrasekhar","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Veena","family":"Mangalan","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aravind S","family":"Raj","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":[[2026,7,15]]},"container-title":["Annals of African Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/aam.aam_691_26","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,2]],"date-time":"2026-08-02T18:57:09Z","timestamp":1785697029000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/aam.aam_691_26"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,15]]},"references-count":0,"URL":"https:\/\/doi.org\/10.4103\/aam.aam_691_26","relation":{},"ISSN":["1596-3519","0975-5764"],"issn-type":[{"value":"1596-3519","type":"print"},{"value":"0975-5764","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,15]]},"assertion":[{"value":"2026-05-26","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-15","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}