{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T19:27:38Z","timestamp":1786649258921,"version":"build-2736575974"},"reference-count":14,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","license":[{"start":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T00:00:00Z","timestamp":1759276800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-sa\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:sec>\n                    <jats:title>Background and Aims:<\/jats:title>\n                    <jats:p>Left head rotation (LeHeR) maneuver improves the glottic view in patients with difficult airway. We aimed to assess whether rotating the head to the left side to 45\u00b0 improved Cormack\u2013Lehane (CL) glottic view during direct laryngoscopy compared to the classic sniffing position. Ease of intubation in the LeHeR position, number of attempts, time taken for intubation, and hemodynamic changes were also assessed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Material and Methods:<\/jats:title>\n                    <jats:p>This prospective, observational study was performed in 130 surgical patients aged 18\u201370 years, of American Society of Anesthesiologists Physical Status 1 and 2. Patients with CL grade 1 on initial direct laryngoscopy and those with restricted mouth opening were excluded. Following induction and neuromuscular blockade, direct laryngoscopy was initially attempted with the patient\u2019s head in sniffing position and CL grade was documented. Then, the head of the patient was rotated 45\u00b0 to the left side, glottic view was graded, and the trachea was intubated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Of the patients, 76.9% showed improvement in CL grade in the LeHeR position. Significantly higher percentage of patients had CL grade 1\u20132B in the LeHeR position compared to that in sniffing position (95.38% vs. 73.8%). Intubation was performed in the LeHeR position in 73.8%, 26.2% patients were intubated in a supine position, and 20% required bougie for intubation. Mean heart rate remained comparable with baseline values throughout the study period. Compared to baseline values, mean blood pressure values were significantly lower.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>LeHeR to 45\u00b0 improved the glottic view during direct laryngoscopy compared to the classic sniffing position. Intubation was easy with good first-attempt success without desaturation or adverse hemodynamic effects.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/joacp.joacp_613_24","type":"journal-article","created":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T17:01:41Z","timestamp":1759338101000},"page":"686-691","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Impact of left head rotation (LeHeR) maneuver on glottic view during direct laryngoscopy: An observational study"],"prefix":"10.4103","volume":"41","author":[{"given":"Lokeshshiva","family":"Arul","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":"VK","family":"Sai Sandhya","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahesh","family":"Madhu","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maneesh S.","family":"Manikandan","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"}]}],"member":"276","published-online":{"date-parts":[[2025,10,1]]},"reference":[{"key":"R1-20251001","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1097\/EJA.0b013e32835103e6","article-title":"A survey of anaesthetic practice in predicting difficult intubation in UK and Europe","volume":"29","author":"McPherson","year":"2012","journal-title":"Eur J Anaesthesiol"},{"key":"R2-20251001","doi-asserted-by":"crossref","first-page":"888","DOI":"10.1007\/s12630-010-9366-5","article-title":"The incidence of hypoxemia during surgery: Evidence from two institutions","volume":"57","author":"Ehrenfeld","year":"2010","journal-title":"Can J Anaesth"},{"key":"R3-20251001","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1213\/ANE.0000000000001421","article-title":"Effects of acute, profound hypoxia on healthy humans: Implications for safety of tests evaluating pulse oximetry or tissue oximetry performance","volume":"124","author":"Philip","year":"2017","journal-title":"Anesth Analg"},{"key":"R4-20251001","doi-asserted-by":"crossref","first-page":"e230201","DOI":"10.1136\/bcr-2019-230201","article-title":"LeHeR, a simple novel approach for difficult airway in non-trauma patients","volume":"12","author":"Yezid","year":"2019","journal-title":"BMJ Case Rep"},{"key":"R5-20251001","doi-asserted-by":"crossref","first-page":"397","DOI":"10.4103\/ija.ija_1211_23","article-title":"Rescue LeHeR manoeuvre during difficult video laryngoscopy to aid endotracheal intubation","volume":"68","author":"Rajan","year":"2024","journal-title":"Indian J Anaesth"},{"key":"R6-20251001","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1016\/j.annemergmed.2018.12.021","article-title":"Is the mallampati score useful for emergency department airway management or procedural sedation?","volume":"74","author":"Green","year":"2019","journal-title":"Ann Emerg Med"},{"key":"R7-20251001","first-page":"477","article-title":"Which test best predicts difficult endotracheal intubation? A prospective cohort study","volume":"29","author":"Alp","year":"2023","journal-title":"Ulus Travma Acil Cerrahi Derg"},{"key":"R8-20251001","first-page":"e28754","article-title":"Predictive value of modified mallampati test and upper lip bite test concerning Cormack and Lehane\u2019s laryngoscopy grading in the anticipation of difficult Intubation: A cross-sectional study at a tertiary care hospital, Bhubaneswar, India","volume":"14","author":"Kar","year":"2022","journal-title":"Cureus"},{"key":"R9-20251001","doi-asserted-by":"crossref","first-page":"300060520925325","DOI":"10.1177\/0300060520925325","article-title":"The \u201cBURP\u201d manoeuvre improves the glottic view during laryngoscopy but remains a difficult procedure","volume":"48","author":"Yu","year":"2020","journal-title":"J Int Med Res"},{"key":"R10-20251001","doi-asserted-by":"crossref","first-page":"e42500","DOI":"10.2196\/42500","article-title":"Left head rotation as an alternative to difficult tracheal intubation: Randomized open label clinical trial","volume":"12","author":"Chan","year":"2023","journal-title":"Interact J Med Res"},{"key":"R11-20251001","doi-asserted-by":"crossref","first-page":"1879","DOI":"10.1177\/00220345000790111101","article-title":"Effects of head and body position on two- and three-dimensional configurations of the upper airway","volume":"79","author":"Ono","year":"2000","journal-title":"J Dent Res"},{"key":"R12-20251001","doi-asserted-by":"crossref","first-page":"432","DOI":"10.1097\/EJA.0000000000000582","article-title":"The effect of head rotation on efficiency of face mask ventilation in anaesthetised apnoeic adults: A randomised, crossover study","volume":"34","author":"Itagaki","year":"2017","journal-title":"Eur J Anaesthesiol"},{"key":"R13-20251001","doi-asserted-by":"crossref","first-page":"244","DOI":"10.4097\/kjae.2016.69.3.244","article-title":"Encountering unexpected difficult airway: Relationship with the intubation difficulty scale","volume":"69","author":"Koh","year":"2016","journal-title":"Korean J Anesthesiol"},{"key":"R14-20251001","doi-asserted-by":"crossref","first-page":"e258012","DOI":"10.1136\/bcr-2023-258012","article-title":"Left head rotation (LeHeR), an innovative approach for intubation in patients with missing and loose teeth","volume":"17","author":"Veparala","year":"2024","journal-title":"BMJ Case Rep"}],"container-title":["Journal of Anaesthesiology Clinical Pharmacology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/joacp.joacp_613_24","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T18:51:17Z","timestamp":1786647077000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/joacp.joacp_613_24"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10]]},"references-count":14,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2025]]}},"URL":"https:\/\/doi.org\/10.4103\/joacp.joacp_613_24","relation":{},"ISSN":["0970-9185","2231-2730"],"issn-type":[{"value":"0970-9185","type":"print"},{"value":"2231-2730","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10]]},"assertion":[{"value":"2024-12-18","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-02-07","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}