Authors: Seung Eun Song et al.
Source: Canadian Journal of Anesthesia, 2025 (advance online publication)
This single-center randomized crossover trial compared a novel laryngoscopy technique, in which the operator uses the left forearm or elbow to maintain head extension by supporting the patient’s forehead, with the conventional direct laryngoscopy method. Eighty-four adults undergoing elective surgery were intubated twice, once with each technique, in randomized order.
Results
The novel technique reduced dental contact incidence (52% vs 77%, P < 0.001) and increased the blade-to-tooth distance (median +1 mm, P = 0.001), the angle of head extension (+4.5°, 95% CI 2.1–6.8), and glottic visualization (higher median POGO score, P = 0.003). The proportion achieving POGO scores of 4–5 improved from 73% to 89% (P = 0.01).
Conclusions
Supporting the patient’s forehead with the left forearm or elbow during laryngoscopy is a simple ergonomic modification that improves the laryngeal view and significantly reduces the risk of dental trauma. This method may be particularly beneficial for frequent intubators, trainees, and patients with restricted mouth opening or difficult visualization.
What You Should Know
• The forearm-supported head extension method reduces dental contact and enhances visualization.
• It improves safety without requiring extra equipment or complex training.
• Awareness of ergonomic positioning is important to avoid operator fatigue.
• Future research should examine its effectiveness in emergency and difficult airway cases.
Thank you to the Canadian Journal of Anesthesia for publishing this valuable contribution to airway management safety.