Left head rotation as an aid for successful intubation in patients with difficult airway: A prospective observational study

Sniffing position(neck flexion and head extension )is a gold standard position for laryngoscopy and intubation. At times may not be sufficient to intubate a patient with difficult airway due to  high Cormack Lehane grade(CL grade). In an anaesthetised patient, the tongue becomes flaccid, as a result tends to fall back, obstructing the airway patency. By left head rotation, we attempt to resolve this issue by utilizing gravity to our benefit. Left head rotation along with laryngoscopy shifts the tongue to the left side and gravity aids to further displace it on the left dependent side hence improving the laryngoscopic view. Fibreoptic bronchoscope , videolaryngoscope etc are used in case one encounters an unanticipated  difficult airway, but there availability and cost are limitations in resource poor areas, thus we plan to use a simple maneuver of left head rotation for improving intubating conditions by improving cormack lehane grading.