Obesity is on the rising trend with a global estimate of 2.5 billion adults in the recent years as per WHO survey. Number of obese patients undergoing elective surgeries are increasing with each passing day, hence, the anesthetist must be prepared to handle all peri operative care of these patients.

This trend is associated with increased difficulty in airway management. In obese patients, due to the anatomical and physiological changes, perioperative complications are to be expected. Anatomical changes such as redundant upper airway tissue, large tongue, and fat deposition in the neck complicate laryngoscopy These factors hinder optimal positioning in the traditional “sniffing the morning air” posture, prompting the exploration of alternative techniques .

Proper positioning of head and neck is important for optimizing glottic view which promotes the likelihood of successful intubation and decreases the number of laryngoscopy attempts. Head-elevated and 25° back-up positions have emerged as promising strategies to enhance glottic visualization, mask ventilation and intubation success in this high-risk population consisting of patients with obesity.