Turkish Journal of Anaesthesiology and Reanimation

Original Article

Comparison of the Glottic Views in a Head Elevated Laryngoscopy Position with the Patient in Supine or 25º Backup: An Observer-Blinded Randomised Clinical Trial

10.5152/TJAR.2021.1058

Janani Nandhakumar
Hemanth Kumar Vadlamudi Reddy
Indubala Maurya
Kusha Nag

Received Date: 08.08.2020 Accepted Date: 01.02.2021 Turk J Anaesthesiol Reanim 2021;49(6):453-459

Abstract
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Background:

Simple manoeuvres such as Head elevated laryngoscopy position (HELP) can facilitate a better glottic view. We conducted this prospective randomized clinical trial to compare the glottic view in a head elevated laryngoscopy position with the same patient in supine and 25° backup position.

Methods:

A total of 180 patients aged between 18-65 years, planned for elective surgery under general anaesthesia with endotracheal intubation using Macintosh laryngoscope were included. Any patient with anticipated airway difficulty, emergency surgeries or rapid sequence induction was excluded. All patients were randomized into two groups (Group B=90, Group S= 90). In group S, the glottic view was assessed while the patients were in 25° back up HELP position (1st position). Then the patients were repositioned and intubated in supine HELP (2nd position) position after reassessing the glottic view. In group B, the glottic view was assessed while the patients were in the supine HELP position (1st position). Then the patients were repositioned and intubated in 25° backup HELP position (2nd position) after reassessing the glottic view. Percentage of glottis opening score (POGO), Cormack Lehane (CL) Grade, laryngoscopy time, intubation time, attempts for intubation, anaesthesiologists comfort, use of ancillary devices/ manoeuvres and ease of intubation were recorded.

Results:

The mean POGO score was significantly more in 25° backup than supine position (n=180; 25° backup HELP: 64.78 ±26.83 % vs Supine HELP: 46.96±27.71 %, p- value< 0.0001). The Cormack Lehane grade was significantly higher in the supine HELP position than 25° backup HELP position (n=180, p-value<0.0001). The mean laryngoscopy time was comparable between two positions (n=180, Supine with HELP: 9.38±3.80 sec, 25° backup with HELP: 9.47±3.80 sec; p-value: 0.608). The mean intubation time was significantly shorter (p-value: 0.001) in Group B (7.7±2.2 seconds) than Group S (9.2± 3.6 seconds).