Comparison of POGO score in neutral and extended head positions during awake orotracheal intubation using a flexible bronchoscope in adults with difficult airways

Background and Aims: There is a lack of research on the best head position for orotracheal intubation using a flexible fiberoptic bronchoscope (FOB) in cases of nasal pathology and restricted mouth opening, such as in trauma. We conducted a study to compare the effects of neutral and extended head positions for awake fiberoptic orotracheal intubation. Material and Methods: The study was a prospective, randomized comparative study on 50 patients aged 19–70. After obtaining ethical clearance and written informed consent, the patients were randomly divided into two groups, with 25 patients in each group. In Group E, a 7-cm pillow was positioned under the shoulder to keep the occiput close to the operating table. In Group N, no pillow was used during fiberoptic bronchoscopy and intubation. The primary objective entailed the comparison of the percentage of glottic opening score (POGO) between the two groups. The secondary objectives encompassed the measurement of the time required for the insertion of flexible FOB from the incisors to the carina (T1) and the time taken for advancement of the endotracheal tube into the trachea over FOB (T2). Results: The POGO score was significantly higher in Group E compared to Group N ( P < 0.0001), while T1 and T2 were significantly lower in Group E ( P < 0.001). The hemodynamic parameters and postoperative complications were comparable between the groups. Conclusion: The extended head position improves the POGO score and reduces the insertion time for oral awake fiberoptic intubation.