Effect of Left Head Rotation Maneuver on Glottic View in Pediatric Patients during Direct Laryngoscopy: A...

Achieving an optimal glottic view is critical in pediatric anesthesia to prevent hypoxia and bradycardia. The "Left Head Rotation" (LeHeR) maneuver has been proposed as a simple technique to improve laryngeal exposure. This study evaluated the impact of 45° LeHeR on Cormack-Lehane (CL) grading in pediatric patients compared to the classic sniffing position.

We conducted a prospective and observational study of 40 ASA I-II patients (aged 5-14 years) undergoing elective surgery. Following standardized induction, direct laryngoscopy was performed in the sniffing position using Macintosh laryngoscope. Patients with CL Grade II-IV were included. The head was then rotated 45° 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).

Improvement in CL grade was observed in 80% ( n = 32) of patients upon rotating the head to the left ( P < 0.001). Distribution shifted significantly from predominantly CL III ( n = 29) in the sniffing position to CL II ( n = 28) in the LeHeR position. The mean time to intubate was 32.08 ± 11.52 s, with a 92.5% first-attempt success rate. Hemodynamics and SpO2 remained stable throughout the procedure.

The LeHeR maneuver significantly improves glottic visualization in pediatric patients with initially poor views, providing a safe and effective alternative for difficult airway management.