J Anaesthesiol Clin Pharmacol
· 2026 · PMID 42088172
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BACKGROUND AND AIMS: Thoracic paravertebral block (PVB) is the current gold standard technique for perioperative analgesia in breast surgeries. However, it has been associated with axillary sparing. Hence, we have attemp...BACKGROUND AND AIMS: Thoracic paravertebral block (PVB) is the current gold standard technique for perioperative analgesia in breast surgeries. However, it has been associated with axillary sparing. Hence, we have attempted here to block the nerve supply of the entire chest wall with multiple nerve blocks given as the complete antethoracic block (CAB) and compared its analgesic efficacy with the PVB. MATERIAL AND METHODS: Seventy patients between 18 and 70 years, posted for modified radical mastectomy, were included and analyzed in this study. These patients were randomly allocated to group A or B to receive PVB or CAB, respectively. Thoracic paravertebral block was given to Group A patients with 25 ml of 0.5% ropivacaine. Complete antethoracic block was given with 60 ml of 0.2% ropivacaine. Duration of analgesia, postoperative pain scores, and patient satisfaction scores were noted. The statistical software STATA (version 14) was used for all statistical analyses. RESULTS: The CAB group had a longer duration of analgesia than the PVB group, but noninferiority could not be established because the upper limit of the confidence interval (CI) exceeded both margins. Lower pain scores were recorded in the first 2 hours in the CAB group. There was no significant difference in terms of patient satisfaction between the two groups. CONCLUSIONS: CAB is a potential alternative technique for providing analgesia for breast surgeries and can be considered in breast surgeries where PVB is not feasible.
Bhardwaj M, Kumari D, Lal J
… +4 more, Bhardwaj D, Kaur K, Punia A, Singhal SK
J Anaesthesiol Clin Pharmacol
· 2026 · PMID 42088171
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BACKGROUND AND AIMS: Second-generation supraglottic airway devices (SADs) have the risk of gastric insufflation and aspiration with positive pressure ventilation. Gastric ultrasound is an emerging point-of-care tool used...BACKGROUND AND AIMS: Second-generation supraglottic airway devices (SADs) have the risk of gastric insufflation and aspiration with positive pressure ventilation. Gastric ultrasound is an emerging point-of-care tool used to assess gastric volume and evaluate perioperative aspiration risk. Hence, we planned this study to compare gastric insufflation using ultrasound between the LMA Protector and i-gel. The primary outcome was to compare the antral cross-sectional area (CSA) between the two SADs. Secondary outcomes included comparison of oropharyngeal leak pressure, peak airway pressure, and postoperative complications. MATERIAL AND METHODS: After institutional ethics committee approval and trial registration, 92 patients aged 18-60 years with American Society of Anesthesiologists physical status I/II/III were recruited. Patients were randomly allocated to groups I (i-gel) and (LMA Protector). Antral CSA and gastric volume were evaluated before induction, after facemask ventilation (FMV), and before removal of SAD. Categorical variables were analyzed using Chi-square or Fisher's exact test. Quantitative variables (CSA, gastric volume) were analyzed using independent samples -test. RESULTS: The mean antral CSA (cm) and hence gastric volume increased significantly from before induction (2.56; 2.17) to after FMV (2.82; 2.57) and at the end of surgery (3.45; 3.19) in both groups I and P, respectively. However, the difference in CSA and gastric volume between the two groups at any time point was not statistically significant, indicating a comparable increase with both devices ( = 0.147; 0.356; 322). Oropharyngeal leak pressure (cm HO) was significantly higher in group P (32.43) than in I (35.98) ( = 0.008). Peak airway pressure and postoperative complications were similar between the groups. CONCLUSION: Both LMA Protector and i-gel functioned comparably in terms of gastric insufflation.
J Anaesthesiol Clin Pharmacol
· 2026 · PMID 42088170
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BACKGROUND AND AIMS: SCUT blocks the supraclavicular nerve (SCN) and upper brachial plexus trunk, and the clavipectoral fascia block (CPF) blocks the fascia-clavicle nerves. This study compares the SCUT block to the CPFS...BACKGROUND AND AIMS: SCUT blocks the supraclavicular nerve (SCN) and upper brachial plexus trunk, and the clavipectoral fascia block (CPF) blocks the fascia-clavicle nerves. This study compares the SCUT block to the CPFS (CPF block and SCN block), which provides site-specific regional anesthesia (RA) for mid-clavicular surgery. MATERIAL AND METHODS: A prospective, randomized controlled trial with two parallel arms and 1:1 allocation is presented here. 18-60-year-old ASA class 1 or 2 adults scheduled for unilateral mid-shaft clavicular surgery were studied. Group A received SCUT block (4 mL of 2% lidocaine + adrenaline, 4 mL 0.5% bupivacaine, and 2 mL dexamethasone). Group B received CPFS (CPF block and SCN block) with 16 mL of 2% lidocaine + adrenaline, 16 mL of 0.5% bupivacaine, and 2 mL of dexamethasone. Outcomes included block success, partial block success, failure, analgesia duration, and shoulder abduction after block. RESULTS: A total of 30 patients per group were studied. In the SCUT group, block onset time was 5 (2) min, with a 93% success rate, a procedure time of 12 (5) min, and an analgesia duration of 15 (1.75) hours. In comparison, CPFS block onset time was 6 (2) min, success rate was 80%, procedure time was 12 (3) min, and analgesia duration was 6 (2) hours. Shoulder abduction was absent in the SCUT group but present in the CPFS group in all blocked patients. CONCLUSION: The SCUT and CPFS blocks are effective and site-specific for mid-shaft fracture clavicle surgery. However, the duration of analgesia is longer with the SCUT block requiring a lower drug volume. The CPFS block allows better shoulder movement. Both blocks have similar success rates, onset times, and procedure times.
Arora P, Kathuria S, Jain R
… +2 more, Gupta S, Jain S
J Anaesthesiol Clin Pharmacol
· 2026 · PMID 42088168
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BACKGROUND AND AIMS: Post-spinal anesthesia hypotension (PSAH) is associated with significant adverse outcomes, prompting extensive research into predictive markers. This study aimed to evaluate and compare the predictiv...BACKGROUND AND AIMS: Post-spinal anesthesia hypotension (PSAH) is associated with significant adverse outcomes, prompting extensive research into predictive markers. This study aimed to evaluate and compare the predictive value of the internal jugular vein collapsibility index (IJV-CI) and common carotid artery peak systolic velocity variation (CCA-PSV) in forecasting PSAH. MATERIAL AND METHODS: A prospective observational study was conducted on 53 ASA I, II, and III adult patients undergoing elective surgery under spinal anesthesia (SAB). IJV-CI and CCA-PSV were examined using ultrasonography in all patients. SAB was administered using a standard protocol. PSAH was defined as a reduction of systolic blood pressure (SBP) ≥20%. Our primary objective was to evaluate the predictive value of IJV-CI and CCA-PSV for PSAH. The secondary objective was to compare their diagnostic efficacy. RESULTS: PSAH was found in 39.6% (21 out of 53) patients. The area under the ROC curve for IJV-CI was 0.769 (95% CI: 0.903-0.636, = 0.001). IJV-CI > 21.58% predicted PSAH with 71.43% sensitivity, 84.38% specificity, and 79.25% accuracy. The area under the ROC curve for CCA-PSV was 0.760 (95% CI: 0.888-0.631, = 0.002). CCA-PSV >12.16% predicted PSAH with 85.71% sensitivity, 56.25% specificity, and 67.92% accuracy. With the maximum % fall in SBP, IJV-CI had a significantly low-positive correlation ( = 0.298, = 0.030), and CCA-PSV had a significant moderate positive correlation ( = 0.483, = 0.0002). CONCLUSIONS: Both IJV-CI and CCA-PSV are reliable predictors of PSAH. In terms of accuracy, IJV-CI is a better predictor of hypotension post-spinal anesthesia as compared to CCA-PSV.
J Anaesthesiol Clin Pharmacol
· 2026 · PMID 42088167
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BACKGROUND AND AIMS: Neuraxial ultrasound (USG) can increase the success rate of neuraxial blocks, such as combined spinal-epidural (CSE). The two commonly practiced approaches for CSE are midline and paramedian. However...BACKGROUND AND AIMS: Neuraxial ultrasound (USG) can increase the success rate of neuraxial blocks, such as combined spinal-epidural (CSE). The two commonly practiced approaches for CSE are midline and paramedian. However, only a few studies have compared the USG-assisted midline and paramedian approaches. Therefore, we planned this study to evaluate and compare the efficacy of USG-assisted paramedian and midline approach for CSE anesthesia. MATERIAL AND METHODS: Eighty american society of anesthesiologists (ASA) grade I/II patients undergoing elective orthopedic surgery under CSE anesthesia were enrolled. Patients were allocated to Group M (midline) or Group (paramedian group) for the USG-assisted CSE block. The primary outcome was the first-pass success rate. The secondary outcomes were the second-pass success rate, the number of needle insertions, the number of needle redirections, image quality score, scan time, and procedure time. RESULTS: The first-pass success rate was statistically comparable for Groups and M (26.31% vs. 34.21%; = 0.469). The number of needle insertions in Group was statistically lower than in Group M ( = 0.021), and the number of redirections was statistically comparable between the two groups ( = 0.607). The image quality score was comparable for both groups. The scan time required for USG was statistically less in Group than in Group M (224 sec vs 183 sec, < 0.0001). The procedure time was, however, statistically comparable between the two groups ( = 0.297). CONCLUSIONS: USG-assisted midline and paramedian approaches for CSE have comparable first-needle pass success rates.
John SP, Tripathy DK, Singla D
… +3 more, Talawar P, Kaushal A, Thakuria R
J Anaesthesiol Clin Pharmacol
· 2026 · PMID 42088165
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BACKGROUND AND AIMS: Previous studies found that low-flow sevoflurane anesthesia in respiratory mechanics is comparable with higher flow during laparoscopic surgery, but metabolic flow has not been studied adequately. Th...BACKGROUND AND AIMS: Previous studies found that low-flow sevoflurane anesthesia in respiratory mechanics is comparable with higher flow during laparoscopic surgery, but metabolic flow has not been studied adequately. The study compares the effect of metabolic flow with the low-flow technique on respiratory mechanics during laparoscopic procedures. MATERIAL AND METHODS: Sixty adult patients of either sex, American Society of Anesthesiologists physical status I-II scheduled for laparoscopic surgery of <3 h were randomly assigned into group M: metabolic (n = 30) and group L: low-flow anesthesia (n = 30). Both groups received fresh gas flow (FGF) of 6 L/min of oxygen, air, and sevoflurane until they attained a minimum alveolar concentration (MAC) of 1; FGF was changed to 1 L/min in group L. In group M, the FGF was changed to estimate the metabolic flow of oxygen (Brody's formula) plus the leak detected during the pre-use check. The delivered FiO was maintained above 50%, and The dial concentration of sevoflurane was adjusted to maintain a target MAC-1 throughout the procedure in both groups. The primary objective was to compare postoperative forced vital capacity (FVC) after achieving a Modified Aldrete Score of ≥9. The secondary objectives included comparing arterial blood gas (ABG) parameters, hemodynamic parameters, and sevoflurane consumption. RESULTS: There was no statistically significant difference in the FVC, ABG, and hemodynamic parameters between the two groups pre- (T1) and postoperatively (T2, T3, T4). There was a statistically significant decrease in sevoflurane consumption ( = <0.001) in the metabolic-flow group. CONCLUSIONS: The effects of metabolic-flow anesthesia on pulmonary mechanics and gas exchange were similar to those of the low-flow anesthesia technique.
Babul A, Ashraf S, Desai J
… +3 more, Free L, Hussain M, Babul N
J Anaesthesiol Clin Pharmacol
· 2026 · PMID 42088161
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BACKGROUND AND AIMS: Phenylephrine is widely used to manage postspinal hypotension during cesarean delivery under neuraxial anesthesia. However, the optimal method of administration, bolus or infusion, remains uncertain....BACKGROUND AND AIMS: Phenylephrine is widely used to manage postspinal hypotension during cesarean delivery under neuraxial anesthesia. However, the optimal method of administration, bolus or infusion, remains uncertain. MATERIAL AND METHODS: This systematic review and meta-analysis (PROSPERO CRD420251081996) included randomized controlled trials comparing phenylephrine bolus and infusion regimens during cesarean delivery. The primary outcome was maternal hypotension. Secondary outcomes included reactive hypertension, bradycardia, intraoperative nausea and vomiting, and neonatal outcomes such as Apgar scores, umbilical arterial pH, and paO. A random-effects model was used for meta-analysis, and trial sequential analysis (TSA) was performed to evaluate the robustness of the evidence. RESULTS: Twenty randomized controlled trials involving 2742 parturients (bolus n = 1314; infusion n = 1428) were included. Overall, there was no significant difference in predelivery hypotension between infusion and bolus regimens (RR 0.95, 95% CI 0.70-1.30; I² =94%). However, in a subgroup of fixed-rate infusions, a reduction in hypotension was observed compared with bolus (RR 0.73; 95% CI 0.61-0.88). Infusion was associated with a higher risk of reactive hypertension, while bradycardia and other maternal outcomes were similar. Although Apgar scores and UA pH showed minor statistical differences, all neonatal values remained within normal clinical ranges. TSA confirmed sufficient evidence only for the fixed-rate infusion subgroup; the overall pooled estimate remained inconclusive. CONCLUSIONS: Phenylephrine infusion, particularly fixed-rate prophylactic infusion, may reduce hypotension, but the overall evidence does not demonstrate superiority over bolus dosing. Given the very high heterogeneity and increased reactive hypertension with infusion, results should be interpreted cautiously. Neonatal outcomes were clinically comparable between groups.
Malhotra N, Sinha N, Kumar A
… +3 more, Ritu, Gupta D, Malhotra N
J Anaesthesiol Clin Pharmacol
· 2026 · PMID 41542215
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BACKGROUND AND AIMS: Shoulder pain, often characterized by gradual progression and reduced glenohumeral joint mobility, can arise from inflammatory, traumatic, or degenerative causes. Treatment aims to relieve symptoms,...BACKGROUND AND AIMS: Shoulder pain, often characterized by gradual progression and reduced glenohumeral joint mobility, can arise from inflammatory, traumatic, or degenerative causes. Treatment aims to relieve symptoms, improve joint mobility, and enhance quality of life. This study compared the effectiveness of platelet-rich plasma (PRP) injections with a combination of local anesthetic and steroid in patients with chronic shoulder pain, focusing on pain relief and functional improvement. MATERIAL AND METHODS: Fifty patients under 20 years old with shoulder pain unresponsive to 6 weeks of conservative treatment were randomly assigned to two groups. Group I received an injection of 3 mL of 0.25% bupivacaine and 1 mL triamcinolone, while Group II received 3 mL of PRP. Pain and function were evaluated using the Numeric Rating Scale (NRS), Shoulder Pain and Disability Index (SPADI), and patient satisfaction, with side effects monitored. RESULTS: Demographic variables were comparable. Significantly lower pain scores were observed at half an hour, 2 weeks, and 1 month in group I, while in group II, reduced pain scores were observed at 2, 3, and 6 months ( < 0.05). After 6 months, better patient satisfaction was observed in group II ( < 0.05). SPADI was statistically comparable at all time intervals, except at half an hour, 2 weeks after injection, when it was significantly better in group I. CONCLUSIONS: Both interventions are safe and effective methods for the treatment of chronic shoulder pain, leading to pain relief and improvement in physical disability. However, intra-articular PRP injection offers a more sustained and longer-lasting improvement compared to corticosteroids and bupivacaine.
J Anaesthesiol Clin Pharmacol
· 2026 · PMID 41542214
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INTRODUCTION: For oral care and prevention of ventilator- associated pneumonia (VAP) in patients admitted to intensive care units (ICU), chlorhexidine gluconate is the commonly used antiseptic solution. Recent studies, h...INTRODUCTION: For oral care and prevention of ventilator- associated pneumonia (VAP) in patients admitted to intensive care units (ICU), chlorhexidine gluconate is the commonly used antiseptic solution. Recent studies, however, have shown uncertainty regarding its benefit, with some reporting increased mortality in patients. MATERIAL AND METHODS: This randomised controlled study was performed on 154 patients who were receiving invasive mechanical ventilation for more than 48 hours. The patients were randomised into two study groups; in Group I oral care was provided with chlorhexidine gluconate solution, and in Group II a comprehensive oral care protocol that omitted chlorhexidine was adopted. The primary outcome of the study was patient outcome at 14 days after enrolment and secondary outcomes included incidence of VAP and oral health assessment. RESULTS: We found that the oral hygiene in the study groups was comparable. The incidence of VAP was significantly higher in Group I as compared to Group II (40.2% vs 23.3%; = 0.025). The mortality observed in Groups I and II at 14 days after study enrollment was 67.9% and 54.5% respectively ( = 0.002). In logistic regression analysis, the comorbidities, VAP and patients with underlying neurological conditions were found to be the independent factors affecting the mortality of patients. CONCLUSION: A comprehensive oral care regime consisting of mechanical disruption of dental plaque, moisturization of lips and oral cavity compared to chlorhexidine -based oral care is found to be more effective in reducing VAP in mechanically ventilated patients admitted in a general ICU.
Somayaji S, Karanth N, Ganigara A
… +2 more, Chandrika YR, Shahnaz SS
J Anaesthesiol Clin Pharmacol
· 2026 · PMID 41542213
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BACKGROUND AND AIMS: Infants are at the highest risk of oxygen desaturation during induction of anesthesia owing to their distinct anatomical and physiological characteristics. Prolongation of non-hypoxic safe apnea time...BACKGROUND AND AIMS: Infants are at the highest risk of oxygen desaturation during induction of anesthesia owing to their distinct anatomical and physiological characteristics. Prolongation of non-hypoxic safe apnea time by use of positive end expiratory pressure (PEEP) during induction has been studied extensively in adults. Although few studies have been conducted in infants, they lacked methodological rigor. Hence, we designed a scientifically rigorous study aimed at investigating the effects of application of PEEP during induction of anesthesia on the duration of non-hypoxic apnea time in infants. MATERIAL AND METHODS: Seventy-two infants were induced as per institutional protocol and mechanically ventilated for three minutes with volume-controlled ventilation and set ventilator parameters with PEEP of either 7 cm HO or 0 cm HO according to the group allocated, followed by endotracheal intubation. The duration of non-hypoxic apnea time, i.e., the duration from cessation of mechanical ventilation to the point when SpO reached 95%, was noted. Inferential statistics were done by using the independent 't' test, Mann Whitney test and Chi square test. RESULTS: The duration of non-hypoxic apnea time was significantly longer in the PEEP group (n = 33) as compared to the control group (n = 33); 122 s (IQR = 52) vs. 95 s (IQR = 27) ( = 0.001) The duration of non-hypoxic apnea time increased significantly as the age of the infant increased. CONCLUSIONS: Addition of PEEP of 7 cmHO is a useful ventilatory strategy in infants to offset undesired changes in the respiratory physiology during induction of anesthesia.
Kaur J, Kundra S, Jain R
… +2 more, Kundra S, Singh T
J Anaesthesiol Clin Pharmacol
· 2026 · PMID 41542212
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BACKGROUND AND AIMS: Incidence and severity of postoperative sore throat (POST) is expected to be higher after lumbar spinal surgery performed under general anesthesia in the prone position. This study aims to compare th...BACKGROUND AND AIMS: Incidence and severity of postoperative sore throat (POST) is expected to be higher after lumbar spinal surgery performed under general anesthesia in the prone position. This study aims to compare the efficacy and safety of preoperative gargles with aspirin and magnesium sulphate for prevention of POST after lumbar laminectomy. MATERIAL AND METHODS: This prospective, randomized, double-blinded study was conducted on 60 adult American Society of Anesthesiologists grade I-III patients posted for lumbar laminectomy under general anesthesia. Patients, allocated into two groups of 30 patients each, received a solution of either aspirin 325 mg (Group A) or magnesium sulphate 1 g (Group B) dissolved in 20 ml of 5% dextrose to gargle for 30 s, 15 min before induction of anesthesia. Postoperatively, incidence, severity grade, and numeric rating scale (NRS) of POST were assessed at 1, 2, 4, 12, and 24 h. Incidence and severity of postoperative cough were assessed at 0, 1, 2, 4, 12, and 24 h. RESULTS: Incidence and severity grade of POST were significantly lower in Group B as compared to Group A at 1 h ( = 0.01, 0.002), while these were similar at 2, 4, 12, and 24 h postoperatively. NRS for POST was significantly lower at 1, 2, and 4 h in Group B ( = 0.002, 0.035, 0.024), whereas it was comparable at 12 and 24 h. No significant difference was observed in incidence and severity of postoperative cough. CONCLUSION: Magnesium sulphate gargles are more effective than aspirin in preventing POST in the early hours of the postoperative period.
Sushmitha A, RanjithKumar M, Vinayagam S
… +1 more, Vasudevan A
J Anaesthesiol Clin Pharmacol
· 2026 · PMID 41542211
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BACKGROUND AND AIMS: Postspinal hypotension (PSH) is a common adverse event following spinal anesthesia, with a pronounced incidence among diabetic individuals due to autonomic neuropathy. This study aimed to assess the...BACKGROUND AND AIMS: Postspinal hypotension (PSH) is a common adverse event following spinal anesthesia, with a pronounced incidence among diabetic individuals due to autonomic neuropathy. This study aimed to assess the caval aorta index (IVC/AO) and IVC collapsibility index (IVCCI) as predictors of PSH. MATERIAL AND METHODS: One hundred and twenty patients scheduled for elective surgeries under spinal anesthesia were divided into two groups: Group A (Diabetic) and Group B (nondiabetic). IVC and aorta diameters were measured to calculate the IVC/AO index and IVCCI. Patients in both groups received spinal anesthesia using 0.5% bupivacaine (3 ml). Hemodynamic parameters were recorded, and the incidence of PSH was noted. The odds ratio for PSH was ascertained between the groups, and correlations of age, body mass index, diabetes duration, and random blood glucose levels with the IVC/AO index were performed. Receiver operating characteristic curves were used to evaluate the diagnostic value of the IVC/AO index and IVCCI for predicting PSH. A value of <0.05 was considered statistically significant. RESULTS: PSH was observed in 82 patients (68%), with 58 in group A and 24 in group B. Diabetics had a lower IVC/AO index ( < 0.002) and a significantly elevated IVCCI ( < 0.001). The IVC/AO index of <1.065 indicated an increased odds ratio (5.5) for developing PSH. A strong negative correlation was noted between the duration of diabetes and IVC/AO index. CONCLUSIONS: Preoperative ultrasonographic measurement of the IVC/AO and IVCCI indices is a useful predictors of PSH in diabetic patients.
J Anaesthesiol Clin Pharmacol
· 2026 · PMID 41542210
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BACKGROUND AND AIMS: This prospective, randomized, double-blind controlled trial investigated whether adding perineural dexamethasone and dexmedetomidine to ropivacaine in adductor canal block (ACB) improves postoperativ...BACKGROUND AND AIMS: This prospective, randomized, double-blind controlled trial investigated whether adding perineural dexamethasone and dexmedetomidine to ropivacaine in adductor canal block (ACB) improves postoperative analgesia compared to using only perineural dexamethasone with ropivacaine in patients undergoing total knee arthroplasty (TKA). MATERIAL AND METHODS: Fifty-eight patients undergoing TKA received ultrasound-guided ACB (30 mL of 0.5% ropivacaine). They were randomly assigned to receive either perineural dexamethasone (4 mg) or a combination of perineural dexamethasone (4 mg) and dexmedetomidine (50 mcg), with 29 participants in each group. A blinded observer assessed the primary outcome: morphine consumption in the first 24 postoperative hours. Secondary outcomes included total 48-hour morphine consumption, postoperative pain scores (NRS) at rest and during movement, quadriceps muscle strength, timed up and go (TUG) test time, Ramsay sedation score, and incidence of nausea, vomiting, hypotension, bradycardia, and desaturation. RESULTS: The dexamethasone-dexmedetomidine group showed significantly lower 24-hour (14.38 ± 5.68 mg vs. 8.55 ± 4.37 mg, = 0.0001) and 48-hour (20.96 ± 7.09 mg vs. 12.06 ± 6.11 mg, = 0.00001) morphine consumption compared to the dexamethasone-only group. Pain scores at rest and with movement were also lower in the combination group during the first 12 postoperative hours. No significant between-group differences were observed in other secondary outcome measures (quadriceps strength, TUG time, sedation score, and complication rates). No serious adverse events were reported in either group. CONCLUSION: The study suggests that adding dexamethasone and dexmedetomidine to ropivacaine for ACB may significantly improve postoperative pain relief in TKA patients without causing harmful side effects.
Yadav S, Shukla A, Hemlata
… +3 more, Chaurasiya MK, Verma R, Kohli M
J Anaesthesiol Clin Pharmacol
· 2026 · PMID 41542209
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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 tr...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 ( < 0.0001), while T1 and T2 were significantly lower in Group E ( < 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.