LeHeR, a simple novel approach for difficult airway in non-trauma patients

What is it about?

Managing difficult airway in remote hospital with limited resources of advanced airway possess real challenge. Difficult airway is defined as a clinical situation in which a conventionally trained anesthesiologist experiences difficulty with face mask ventilation of the upper airway, difficulty with tracheal intubation or both. The incidence ranges from 0.4-8.5% in anesthesia, and much higher at 2-14.8% in emergency medicine. Patients who are difficult to intubate are at higher risk for airway related complications e.g. aspiration, oesophageal intubation or oropharyngeal trauma. Failed intubation also might cause prolonged hypoxia thus increasing morbidity and mortality. Although there are many methods and scoring systems available to predict and anticipate difficult airway, the dictum in emergency airway is to always expect the unexpected. We report four cases of difficult airway encountered in our district hospital from November 2017 to December 2018, in which intubation was performed using simple manoeuvre called Supine with Left Head Rotation (LeHeR).In all these cases, LeHeR maneuver has proven to be successful after more than a single attempt at intubation using various methods. The maneuver improves drastically the laryngoscopic view of Cormack-Lehane from 3B and 4 to 1 and 2.

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