Ramped positioning modifies the effect of cricoid and left paratracheal pressure on perceived glottic-view quality during videolaryngoscopy in adults with obesity: a secondary image-based analysis
Authors' conclusion
In adults with obesity, ramped positioning modified the effect of external laryngeal compression on perceived glottic-view quality during VL. NP yielded the most favourable ratings overall.
Study context
- Population
- De-identified videolaryngoscopy (VL) images from adults with obesity, rated by blinded anaesthesia clinicians340 raters
- Participants
- 91 participants · 273 images
- Comparison
- No pressure (NP) vs left paratracheal pressure (LPP) vs cricoid pressure (CP), each in supine or Rapid Airway Management Position (RAMP) position, during VL
- Primary endpoint
- Perceived glottic-view quality (three-point scale)
Methodological detailsretrospective, image-based, blinded raters, cumulative ordinal models with threshold-specific effects, robust SEs clustered by rater
- Retrospective, image-based
- Blinded raters
- Cumulative ordinal models with threshold-specific effects
- Robust SEs clustered by rater
Primary result
As reported in the abstract
Perceived glottic-view quality
- NP yielded the highest proportion of favourable ratings in both positions
- Supine: LPP rated more favourably than CP
- Ramped: CP and LPP broadly similar proportions of favourable ratings despite a statistically significant but small absolute difference
- CP × RAMP interaction: attenuation of the adverse CP-associated effect in the ramped position
- 59,956 ratings analysed
Further findings
Inter-rater agreement
- Fair to moderate
Original publication
Ramped positioning modifies the effect of cricoid and left paratracheal pressure on perceived glottic-view quality during videolaryngoscopy in adults with obesity: a secondary image-based analysis. Anaesth Crit Care Pain Med. Published 22 September 2026. doi:10.
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