Non-channelled video laryngoscopy versus direct laryngoscopy for improving hemodynamics and intubation time in ASA 1 and 2 patients, a double blinded randomized controlled trial

Abstract

Background

In 2022, the American Society of Anaesthesiologists (ASA) included indirect video laryngoscopy in their difficult airway algorithm to aid in difficult intubation. To determine the potential advantages of routinely using video laryngoscopy (VL) in nonchallenging cases, we conducted a study to examine its effects on hemodynamics, intubation time and fasting blood sugar (FBS) in comparison with direct laryngoscopy (DL).

Methodology

This was a double blinded, prospective, randomized, controlled trial in a university hospital included ASA I to II patients undergoing elective surgery. Patients were randomly assigned to either DL or VL with an endotracheal tube preshaped to the blade through a stylet. The primary outcome was the difference in the mean blood pressure (MBP) post intubation. Secondary outcomes included intubation time, Cormack–Lehane grade, FBS levels and other hemodynamic differences. The study was registered at (pactr.samrc.ac.za), number PACTR202305589924304.

Results

80 patients were enrolled and intubated with either DL (n = 40) or VL (n = 40), MBP, HR, DBP, intubation time and Cormack–Lehane grade were significantly better with indirect video laryngoscopy with pre-shaped stylet than with direct laryngoscopy, with mean values of 78.83 vs 90.50 mmhg, 84.78 vs 92.13, 78.83 vs 90.50 mmhg, 15.63 vs 17.28 s respectively, but the effects of direct laryngoscopy on FBS, SBP, and saturation were not significantly different.

Conclusion

Indirect video laryngoscopy is superior to direct laryngoscopy regarding patient's hemodynamics specially the MBP, intubation time with no significant difference regarding FBS.