Sniffing Position vs Left Head Rotation (LeHeR) Maneuver for Glottic View During Direct Laryngoscopy

The left head rotation (LeHeR) maneuver, in which the head of the supine patient is rotated 45° to the left, is a simple, equipment-free technique proposed to improve laryngeal view during laryngoscopy. Published results are conflicting: self-controlled studies report improvement, whereas parallel-group and large cohort studies do not. This prospective, observational, self-controlled study aims to compare the glottic view obtained in the standard sniffing position with that obtained in the 45° LeHeR position in the same adult patients undergoing elective surgery under general anesthesia with direct laryngoscopy. Glottic view will be graded with the modified Cormack-Lehane classification and the Percentage of Glottic Opening (POGO) score. Intubation difficulty, need for additional maneuvers or adjuncts, hemodynamic changes, and airway trauma will also be recorded.

Inclusion Criteria: * Age 18-70 years * Scheduled for elective surgery under general anesthesia with oral endotracheal intubation * ASA physical status I-III * Modified Cormack-Lehane grade 2-4 on direct laryngoscopy in the sniffing position * Written informed consent Exclusion Criteria: * Limited mouth opening (\