This single-center prospective observational study plans to enroll 196 patients undergoing elective general anesthesia. The study aims to investigate the correlation between preoperative bedside anatomical indicators (including modified Mallampati classification, upper lip bite test, mouth opening, head circumference, and thyromental distance) and the peak lifting force applied during video laryngoscopy, as well as the degree of glottic exposure (POGO score). The study will also evaluate the potential benefit of the direct epiglottis elevation technique in specific anatomical subgroups. After anesthesia induction, the same anesthesiologist will perform video laryngoscopy using two distinct techniques in a fixed sequence: the indirect (vallecula) method and the direct (subepiglottic) method. Peak lifting force will be quantitatively measured in real-time using a resistive thin-film pressure sensor attached to the laryngoscope blade. The primary outcomes are the POGO scores and peak lifting forces under both techniques. The secondary outcome includes the change in POGO score (ΔPOGO) between techniques. The study will provide quantitative evidence regarding the "anatomy-force-view" relationship and aid in individualized clinical decision-making for video laryngoscopy intubation.
- Age 18 to 75 years
ASA physical status I to III
Scheduled for orotracheal intubation under video laryngoscopy guidance
Written informed consent obtained
Known history of difficult airway or anticipated need for awake intubation
Facial or neck trauma, burns, or surgical history affecting palpation of anatomical landmarks
Temporomandibular joint ankylosis or mouth opening < 2.0 cm
Edentulous patients
Adult patients aged 18 to 75 years with ASA physical status I to III who are scheduled for elective surgery under general anesthesia requiring orotracheal intubation under video laryngoscopy guidance. Patients with known difficult airway, facial or neck abnormalities affecting landmark palpation, limited mouth opening (\< 2.0 cm), or edentulism are excluded.
Cohort
Prospective
Direct Epiglottis Elevation (Subepiglottic Method)
Procedure/SurgeryVideo laryngoscopy blade tip advanced past the vallecula and placed under the laryngeal surface of the epiglottis to directly lift it.
Peak Lifting Force with Direct Epiglottis Elevation
Peak lifting force (gf) measured by a resistive thin-film pressure sensor attached to the video laryngoscope blade during the direct (subepiglottic) technique.
Peak Lifting Force with Indirect Epiglottis Elevation
Peak lifting force (gf) measured by a resistive thin-film pressure sensor attached to the video laryngoscope blade during the indirect (vallecula) technique.
POGO Score with Indirect Epiglottis Elevation
Percentage of Glottic Opening (POGO) score assessed via video laryngoscopy using the indirect (vallecula) technique. The scale ranges from 0% to 100%, where higher scores indicate better visualization of the glottis (better outcome).
POGO Score with Direct Epiglottis Elevation
Percentage of Glottic Opening (POGO) score assessed via video laryngoscopy using the direct (subepiglottic) technique. The scale ranges from 0% to 100%, where higher scores indicate better visualization of the glottis (better outcome).
Delta POGO (ΔPOGO)
Incidence of Difficult Glottic Exposure
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