An observational study in Difficult Airway, Difficult Intubation and Video Laryngoscopy, sponsored by Sakarya University. Not yet recruiting. Open to participants aged 18 Years to 70 Years. Per ClinicalTrials.gov, last updated 2026-10-29.
Sponsored by Sakarya University · Observational
The left head rotation (LeHeR) maneuver, in which the head of the supine patient is rotated 45° to the left, is a simple, equipment-free technique proposed to improve the laryngeal view. Studies using the Percentage of Glottic Opening (POGO) score during video laryngoscopy have reported improvement with LeHeR, but evidence is limited and the maneuver has not been systematically evaluated in patients with a predicted difficult airway. This prospective, observational, self-controlled study aims to compare the POGO score obtained in the sniffing position with that obtained in the 45° LeHeR position in the same adult patients with a modified El-Ganzouri Risk Index (EGRI) score above 4 undergoing elective surgery under general anesthesia with video laryngoscopy. Ease of intubation, number and duration of attempts, need for adjuvant maneuvers, hemodynamic changes, and airway trauma will also be recorded.
This single-center, prospective, observational, self-controlled study will be conducted in the operating rooms of the Cekmekoy State Hospital campus of Sancaktepe Sehit Prof. Dr. Ilhan Varank Training and Research Hospital in accordance with the Declaration of Helsinki. Written informed consent will be obtained from all participants. No randomization, blinding, investigational drug, or device is involved. In institutional routine practice, video laryngoscopy is used as standard and the LeHeR maneuver is performed in patients with a modified EGRI score above 4; investigators will not interfere with the anesthesiologist's practice at any stage.
Preoperatively, the EGRI score (mouth opening, thyromental distance, Mallampati class, neck movement, ability to prognath, body weight, history of difficult intubation) will be calculated. After standard monitoring, routine induction of anesthesia and neuromuscular blockade (2 minutes), video laryngoscopy will be performed in the sniffing position with an appropriately sized video laryngoscope blade (e.g., C-MAC Macintosh or D-blade), and the best glottic view will be graded with the POGO score. Patients with a POGO score of 100% will not be studied further. In patients with a POGO score below 100%, the blade will be withdrawn, propofol titrated if needed to maintain anesthetic depth, the head rotated 45° to the left while supine (LeHeR), and video laryngoscopy repeated with POGO grading. Blade type and size will be recorded. If intubation is not achieved in the LeHeR position, routine difficult-airway maneuvers (BURP, external laryngeal manipulation, cuff inflation/deflation, bougie/stylet, return to the sniffing position) will be used and recorded.
The change in POGO score will be compared with the paired t-test or Wilcoxon signed-rank test (p\<0.05). Based on published POGO data, a 20% mean improvement in POGO score was considered clinically meaningful (Cohen's d approximately 0.62, assuming a within-subject correlation of 0.5). Allowing for data loss, 40 patients will be enrolled.
Sakarya University is the lead sponsor of 190 studies on the registry; 53 are open to participants now.
Counted across the registry records on this site, refreshed daily.
Adult patients aged 18-70 years with ASA physical status I-III and a modified El-Ganzouri Risk Index score above 4 who are scheduled for elective surgery under general anesthesia with video laryngoscopy-guided oral endotracheal intubation in the operating rooms of Sancaktepe Sehit Prof. Dr. Ilhan Varank Training and Research Hospital (Cekmekoy State Hospital campus), Istanbul, Turkiye. Consecutive eligible patients will be screened, and those with a POGO score below 100% in the sniffing position will be included.
Go through the criteria one by one — yes, no or not sure — and take the list to your doctor or the study team. Kept in this browser only.
Exclusion Criteria:
Underlined terms in the criteria open these too. Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
The anaesthetists’ scale of health before surgery: I is healthy, II has a mild illness that is under control, III a severe one, IV a severe illness that is a constant threat to life. V and VI are used for the critically ill and for organ donors.
Before you join, the study team explains what taking part involves — its purpose, what happens, the risks and possible benefits — and answers your questions, so you can decide freely. Consent is usually recorded on a form (the informed consent form, ICF) signed by you or, where the law allows, by someone legally authorised to decide for you.
You can keep asking questions during the study, you are told of new information that matters, and you can choose to leave at any time.
ASA physical status
The anaesthetists’ scale of health before surgery: I is healthy, II has a mild illness that is under control, III a severe one, IV a severe illness that is a constant threat to life. V and VI are used for the critically ill and for organ donors.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Informed consent
Before you join, the study team explains what taking part involves — its purpose, what happens, the risks and possible benefits — and answers your questions, so you can decide freely. Consent is usually recorded on a form (the informed consent form, ICF) signed by you or, where the law allows, by someone legally authorised to decide for you.
You can keep asking questions during the study, you are told of new information that matters, and you can choose to leave at any time.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Adult patients (18-70 years, ASA I-III) with a modified El-Ganzouri Risk Index score above 4 undergoing elective surgery under general anesthesia with video laryngoscopy, in whom the POGO score in the sniffing position is below 100%. Each patient undergoes video laryngoscopy first in the sniffing position and then with 45° left head rotation (LeHeR), serving as their own control.
Procedure: Video laryngoscopy in the sniffing position · Procedure: Left Head Rotation (LeHeR) maneuver
After induction of general anesthesia and neuromuscular blockade (2 minutes), video laryngoscopy is performed with an appropriately sized video laryngoscope blade (e.g., C-MAC Macintosh or D-blade) with the head in the standard sniffing position. The best glottic view is graded using the Percentage of Glottic Opening (POGO) score. Patients with a POGO score of 100% are not studied further.
In patients with a POGO score below 100% in the sniffing position, the blade is withdrawn, propofol is titrated if needed to maintain anesthetic depth, the patient's head is rotated 45° to the left while supine, and video laryngoscopy is repeated. The glottic view is graded again using the POGO score and intubation is attempted in this position. If unsuccessful, routine difficult-airway maneuvers (BURP, external laryngeal manipulation, cuff inflation/deflation, bougie/stylet, return to the sniffing position) are used.
Percentage of Glottic Opening (POGO) Score in the Sniffing Position Versus the LeHeR Position
Percentage (0-100%) of the glottic opening visible from the anterior commissure to the interarytenoid notch during video laryngoscopy; higher values indicate a better view. Each patient is assessed first in the sniffing position and then after 45° left head rotation (LeHeR), and the paired scores are compared within the same patient.
Time frame: During video laryngoscopy, approximately 2-10 minutes after induction of general anesthesia
Fremantle Score
Three-part score describing video laryngoscopic intubation: view (full / partial / none), ease (1 = easy, 2 = modified, requiring adjuvant maneuvers or devices, 3 = failed), and device (video laryngoscope type and blade size).
Time frame: During endotracheal intubation, from first laryngoscopy until confirmed tracheal intubation
Number of Intubation Attempts
Total number of laryngoscopy attempts required for successful endotracheal intubation.
Time frame: During endotracheal intubation, from first laryngoscopy until confirmed tracheal intubation
Intubation Time
Time in seconds from passage of the video laryngoscope blade between the lips to the appearance of the first end-tidal carbon dioxide waveform on capnography.
Time frame: During endotracheal intubation, from first laryngoscopy until confirmed tracheal intubation
Number of Participants Requiring Adjuvant Maneuvers or Devices
Number of participants requiring BURP, external laryngeal manipulation, stylet or bougie, cuff inflation/deflation, or return of the head to the sniffing position to achieve intubation.
Time frame: During endotracheal intubation, from first laryngoscopy until confirmed tracheal intubation
Number of Participants With Airway Trauma
Number of participants with signs of airway trauma, defined as blood on the video laryngoscope blade or endotracheal tube, or lip, dental or oropharyngeal mucosal injury.
Time frame: From first laryngoscopy until 5 minutes after intubation
Heart Rate
Heart rate (beats/min)
Time frame: Baseline (before induction), after induction, and at 1, 3 and 5 minutes after intubation
Mean arterial pressure
Mean arterial pressure (mmHg)
Time frame: Baseline (before induction), after induction, and at 1, 3, 5 and 10 minutes after intubation
Peripheral Oxygen Saturation
Peripheral Oxygen Saturation (sPO2)
Time frame: Baseline (before induction), after induction, and at 1, 3, 5 and 10 minutes after intubation
No study locations are listed for this record.
Plan to share: No
No publications or documents are linked to this record.
From the registry record's own update history. This site started tracking changes on Sep 25, 2026; for anything earlier, see the record history on ClinicalTrials.gov ↗
This study is not yet recruiting, as verified in Oct 2026. You cannot join it, but the record below documents what was studied.
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