Videolaryngoscopy versus Direct Laryngoscopy for Endotracheal Tube Placement in Patients Undergoing Emergency Surgical Procedures: A Prospective Observational Study

Introduction: Endotracheal intubation during the induction of general anaesthesia is a routine procedure in the operating room. Traditionally, this procedure has been accomplished using Direct Laryngoscopy (DL) with the Macintosh blade for adults and the Miller blade for children. However, advancements in laryngoscopy techniques have led to the development of Video Laryngoscopes (VL), which have markedly improved the success rates for tracheal intubation in emergency situations and for difficult airways. Aim: To compare the intubation characteristics using VL and direct laryngoscopes for emergency surgical procedures. Materials and Methods: This prospective observational study was conducted in the Department of Anaesthesiology at SKIMS, Soura, Srinagar, Jammu and Kashmir, India, from October 2022 to September 2024. A total of 118 patients of either gender, undergoing emergency surgical procedures, were divided into two groups: Group I (intubated with direct laryngoscope) and Group II (intubated with VL). Each group comprised 59 patients. The efficiency of both techniques was assessed in terms of intubation time, ease of intubation, number of attempts, use of a gum elastic bougie, or external laryngeal manipulation, along with any associated complications. The compiled data were exported to the data editor of Statistical Package for the Social Sciences (SPSS) Version 20.0 and subjected to appropriate statistical analysis. A p-value of <0.05 was considered statistically significant. Results: This study included 118 patients of either gender, aged >18 years, with American Society of Anesthesiologists (ASA) Class I to III, undergoing emergency surgeries. The patients were distributed into two groups: Group I (DL) and Group II (VL), with 59 patients in each group. The mean age of patients in Group I was 47.9±17.68 (mean±SD) years, while in Group II it was 42.9±17.32 (mean±SD) years. The mean glottic visualisation time was shorter for Group I (DL) compared to Group II (VL) (12.8 seconds vs. 13.6 seconds; p-value=0.523). The mean tracheal intubation time was 25.5 seconds in Group I and 27.8 seconds in Group II (p-value=0.322). A greater number of patients in Group I were classified as having a CormackLehane (CL) grade III compared to Group II (27.1% vs. 10.2%; p-value=0.046). Additionally, a greater number of patients in Group I experienced difficult laryngoscopy compared to Group II (27.1% vs. 10.2%; p-value=0.018). A higher proportion of patients in Group I required external laryngeal manipulation for intubation compared to Group II (47.5% vs. 11.9%; p-value <0.001). Conclusion: We observed that VL provides better glottic visualisation and superior ease of intubation compared to the direct laryngoscope. Significantly less external laryngeal manipulation was required for visualising the larynx. We can conclude that VL offers definitive advantages over conventional DL for the management of both difficult and routine airways.