Comparison of intubating conditions in supine and 25 degree backup position using video laryngoscope in elective surgeries under general anaesthesia-A randomized controlled trial.

Airway management is a cornerstone of anaesthesia, with endotracheal intubation being a critical skill. Traditionally, the “sniffing position” has been considered optimal for direct laryngoscopy, but with the advent of video laryngoscopes (VLS), patient positioning may influence visualization and intubation success differently. The 25° back-up position has been suggested to improve pre-oxygenation, laryngeal view, and ease of intubation, though evidence comparing it to the supine position using VLS remains limited.This randomized controlled, double-blinded trial is designed to compare intubating conditions in the supine and 25° back-up positions using a video laryngoscope in adult patients undergoing elective surgeries under general anaesthesia. A total of 74 ASA I–II patients aged 18–65 years will be randomized into two groups: Group A (supine) and Group B (25° back-up).The primary outcome is the ease of intubation assessed by the Modified Intubation Difficulty Score (mIDS). Secondary outcomes include intubation time, video laryngoscope handling time, and peri-intubation complications.By systematically evaluating intubation performance across these positions, the study aims to determine whether the 25° back-up position offers a clinical advantage over the conventional supine posture, thereby guiding optimal positioning strategies for video laryngoscopy in routine anaesthesia practice.