Comparison of Intubating Conditions for Nasotracheal Intubation with BPL® Video Laryngoscope versus Standard Direct Macintosh Laryngoscope using Cuff Inflation Technique: A Randomised Clinical Study

Introduction: Nasotracheal intubation is required in maxillofacial, oral and dental surgeries and it presents unique anatomical and technical challenges. The Macintosh laryngoscope is a gold standard for nasotracheal intubation but requires alignment of the oral, pharyngeal, and laryngeal axis. Conversely, video laryngoscopy helps in the visualisation of the real-time and enlarged video image of airway structures. Aim: To compare two laryngoscopy techniques- British Physical Laboratories® (BPL) video laryngoscope and Macintosh laryngoscope - using the cuff inflation technique to optimise intubation conditions. Materials and Methods: This randomised clinical single-blinded study was carried out in the Department of Anaesthesiology at Dhiraj Hospital, Smt. B.K. Shah Medical Institute and Research Centre (SBKS) Medical Institute and Research Centre (Deemed to be University), Piparia, Waghodia, Vadodara, Gujarat, India, between September 2023 and May 2025, on 66 adult patients divided into two equal groups. Group V patients underwent BPL® video laryngoscopy with cuff inflation, while group M patients underwent Macintosh laryngoscopy with the same technique. Patients were assessed for intubation time, Cormack–Lehane grading, number of attempts, initial 15 mL cuff inflation success, need of additional 5 mL inflation, need for Magill’s forceps or external laryngeal manipulation, haemodynamic parameters like Heart Rate (HR) and Mean Blood Pressure (MBP) and post-procedural complications. The Unpaired t-test was used for numerical variables, and the Chi-square test was used for categorical variables. A p-value <0.05 was considered statistically significant, and a p-value <0.001 was considered highly important. Results: Both groups were comparable in terms of demographic parameters like age, gender, weight, American Society of Anaesthesiologists (ASA) physical status classification and Mallampati Classification of the airway. Group V demonstrated significantly shorter intubation time (31.51±2.16 seconds vs. 45.97±3.15 seconds, p-value <0.001. Initial cuff inflation was more successful in group V (87.88% vs. 48.48%, p-value <0.001). Need for additional 5 mL inflation (12.12% vs 33.33%, p-value=0.04), need for Magill’s forcep (0% vs 18.18%, p-value=0.01) and external laryngeal manipulation (9.09% vs 36.36%, p-value=0.007) were significantly lower in group V. HR and MBP were significantly lower at laryngoscopy and intubation till 5 minutes post-intubation (p-value <0.05) in Group V. The incidence of sore throat (15.15% vs 54.55%, p-value <0.001) and post-procedure bleeding (12.12% vs. 45.45%, p-value=0.003) was significantly lower in group V. Conclusion: The BPL® video laryngoscope with cuff inflation technique demonstrated superior intubating conditions compared to the standard Macintosh laryngoscope, providing shorter intubation times, higher success with initial 15 mL cuff inflation, better haemodynamic stability, and reduced complication rates during nasotracheal intubation.