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.
Maneesh Sheela Manikandan, Sunil Rajan, Fazil Haleel et al.
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In 30 seconds
This prospective, randomized, double-blinded trial compared left head rotation (LeHeR) with direct epiglottis lifting during C-MAC D-blade videolaryngoscopy in 60 adults with difficult airways. Both maneuvers improved percentage of glottic opening (POGO), but the median second POGO was higher with epiglottis lifting than with LeHeR (100 [interquartile range 75-100] vs. 75 [75-100], P = 0.03). Glottic view improved in 96.7% versus 63.3% of patients, respectively (P = 0.002). Intubation time, ease, hemodynamic responses, and desaturation incidence were comparable.
Key findings
- Median second POGO was 100 [interquartile range 75-100] with epiglottis lifting versus 75 [75-100] with LeHeR (P = 0.03).
- Glottic view improved in 96.7% of the epiglottis-lifting group versus 63.3% of the LeHeR group (P = 0.002).
- Both maneuvers improved intragroup POGO scores (P ≤ 0.001).
- Intubation time was comparable (33 ± 12 vs. 31 ± 10 s), as were ease of intubation, hemodynamics, and desaturation incidence.
Why it matters
Glottic visualization is an important component of intubation in patients with difficult airways. In this trial, direct epiglottis lifting produced better measured glottic views than left head rotation, while reported intubation time and other assessed outcomes were comparable. The findings help characterize the relative visualization effects of these two maneuvers with the C-MAC D blade.
What to keep in mind
The trial included 60 patients and assessed glottic visualization and immediate intubation-related outcomes; the abstract does not report longer-term outcomes.