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[3] ELM used to be done by the intubating person to guide the assistant to the best way of doing it to maximize the laryngeal view. This study was designed to test the hypothesis that ELM done by the operator offers the best laryngeal view for intubation. The aim of this study was to examine the changes in laryngoscopic views after ELM done by the intubating person with that done by the assistant with or without guidance from the intubating anesthetist. METHODS After local research ethical committee approval and patients�� informed consent 160 patients underwent different elective surgical procedures were included in this study. Patients [http://en.wikipedia.org/wiki/Aniracetam Aniracetam] aged from 17 to 75 years. Patients requiring direct larygoscopic intubations were included in this study. Patients scheduled [http://www.selleckchem.com/products/ly-411575.html LY411575 nmr] for fiber-optic intubation were excluded from the study. All patients received the same anesthetic technique. Patients were premedicated with midazolam 1-2 mg intravenously approximately 10 min before induction of anesthesia. Induction of anesthesia was done by fentanyl 1 ��g/kg, propofol 1.5-2 mg/kg and cisatracurium 0.15 mg/kg. All laryngoscopies were done by five experienced anesthetists with curved Macintosh blades 3-5. Percentage of glottic opening (POGO) scores[4] and Cormack and Lehane scale[5] were used as outcome measures for comparison between different views. POGO ranged from 0% to 100%. A POGO of 100% denotes full visualization of the larynx from the interarytenoid notch to the anterior commissure of the vocal cords and a POGO score of zero means none of the glottis opening is seen.[4,6] Cormack and Lehane scale[5] consisted of four grades; Grade 1 full view of the glottis, Grade 2 partial view of the glottis or arytenoids, Grade 3 only epiglottis visible and Grade [http://www.selleckchem.com/products/Ki16425.html Ki16425 in vitro] 4 neither glottis nor epiglottis visible. POGO scores and Cormack and Lehane grades were recorded after basic laryngoscopic view, after ELM done by the assistant without guidance from intubating anesthetist, after ELM done by the intubating anesthetist and ELM done by the assistant after guidance from the intubating anesthetist. All data were analyzed with statistical package for the social sciences (SPSS) version 13 for Windows (SPSS Inc., Chicago, IL). Data was presented as numbers, percentages, mean (SD or 95% confidence interval) unless otherwise stated. Wilcoxon signed ranks test was used for comparison with baseline values. Fisher's exact test was used for analyzing the number of the patients having better laryngeal view after ELM. P