Left head rotation manoeuvre to improve laryngoscopic view in elective surgery: A prospective cohort study
Authors' conclusion
The LeHeR manoeuvre failed to significantly improve the direct laryngoscopic view compared to the improved Jackson-position under standard conditions for elective surgery. However, experienced anaesthetists achieved better results with this manoeuvre than novice anaesthetists.
Study context
- Population
- Adults scheduled for elective surgery under GA with endotracheal intubation, without particular aspiration risk
- Participants
- 102 adults
- Exposure
- Left head rotation (LeHeR) manoeuvre vs improved Jackson position
- Outcome
- Laryngoscopic view by modified Cormack and Lehane classification (CLS) and percentage of glottic opening (POGO) score, before and after LeHeR
Methodological detailssingle-centre, Saarland University Hospital, November 2022 to March 2023
- Single-centre
- Saarland University Hospital, November 2022 to March 2023
Main finding
As reported in the abstract
Laryngoscopic view
| Group | Value | Classification score (CLS) grade (median [IQR]) |
|---|---|---|
| Jackson position | median 80 (IQR 42.5–100) percentage of glottic opening (POGO) score | 2a [1 to 2a] |
| LeHeR | median 70 (IQR 42.5–90) POGO score | 2a [1 to 2b] |
Value
Jackson positionmedian 80 (IQR 42.5–100) POGO score
LeHeRmedian 70 (IQR 42.5–90) POGO score
Classification score (CLS) grade (median [IQR])
Jackson position2a [1 to 2a]
LeHeR2a [1 to 2b]
- LeHeR vs Jackson position: P < 0.001 — reduced laryngoscopic view with LeHeR
- LeHeR vs Jackson position: P = 0.041 — reduced laryngoscopic view with LeHeR
Observational data: associations, not effects.
Secondary outcomes
Difference in laryngoscopic view (ΔCLS, ΔPOGO) vs patient characteristics and professional experience
- Longer professional experience vs improvement in POGO (r)
- r = 0.242, P = 0.018
- Longer professional experience vs Cormack and Lehane scores (r), reported as not correlated
- r = −0.29, P = 0.004
- Patient characteristics had no influence on the difference in laryngoscopic views
Original publication
Left head rotation manoeuvre to improve laryngoscopic view in elective surgery: A prospective cohort study. Eur J Anaesthesiol. Published 12 January 2026. doi:10.
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