While upright positioning during intubation provides physiological benefits, the traditional face-to-face approach remains technically challenging because of its reversed spatial orientation and unconventional hand mechanics. Tseng et al. conducted a randomized crossover manikin study comparing the performance of face-to-face versus right-rear approaches for 45° upright intubation. Thirty emergency medicine and anesthesiology providers, all novices to both techniques, were trained and tested using four airway devices: a geometric Macintosh videolaryngoscope, a channeled videolaryngoscope, a hyperangulated videolaryngoscope, and a video stylet. Intubation time was measured from insertion of the laryngoscope into the manikin’s mouth to when the tube passed the vocal cord marker and reached a depth of 20 cm at the incisor level. First-pass success was significantly higher for the right-rear approach (93%) compared with face-to-face (78%), although all participants ultimately achieved successful intubation within 90 seconds. Median intubation times differed by device and technique; notably, both the channeled videolaryngoscope and video stylet achieved 100% first-pass success across approaches by minimizing dependence on glottic alignment. Notably, both the channeled videolaryngoscope and video stylet achieved a 100% first-pass rate for both approaches by reducing the need for glottic angle alignment and precise tube placement. Glottic visualization occurred earlier with the right-rear technique (median 3 s vs 5 s for face-to-face). The authors concluded that the right-rear position provides a more ergonomic alignment resembling conventional midline intubation, likely enhancing operator hand-eye coordination.