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

Background: Simple manoeuvres such as head elevated laryngoscopy position (HELP) can facilitate a better glottic view. We conducted this prospective randomised clinical trial to compare the glottic view in a HELP with the same patient in supine and 25° backup positions. Methods: A total of 180 patients aged between 18 and 65 years who 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 randomised into two groups (group B = 90 and group S = 90). In group S, the glottic view was assessed whilst the patients were in the 25° backup HELP position (first position). Then, the patients were repositioned and intubated in the supine HELP (second position) position after reassessing the glottic view. In group B, the glottic view was assessed whilst the patients were in the supine HELP position (first position). Then, the patients were repositioned and intubated in the 25° backup HELP position (second 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 <.0001). The CL grade was significantly higher in the supine HELP position than the 25° backup HELP position (n = 180, P-value < .0001). The mean laryngoscopy time was comparable between two positions (n = 180, supine with HELP: 9.38±3.80 seconds, 25° backup with HELP: 9.47±3.80 seconds; P-value: .608). The mean intubation time was significantly shorter (P = .001) in group B (7.7±2.2 seconds) than group S (9.2±3.6 seconds). Conclusions: This study has shown that the 25° backup HELP position provides improved glottic view in comparison with the supine HELP position.