Comparative Evaluation of Videolaryngoscopy and Direct Laryngoscopy Performed in Paediatric Patients Undergoing Elective Surgery.

Abstract

Objective: Paediatric airway management poses unique challenges due to anatomical and physiological differences compared to adults. Videolaryngoscopy (VL) has been proposed as a potential improvement over direct laryngoscopy (DL) for tracheal intubation. This study aimed to compare VL and DL in paediatric patients undergoing elective surgery.

Methods: A prospective, randomized study was conducted with 100 paediatric patients aged under 18 years, weighing 10-40 kg, and classified as American Society of Anesthesiologists physical status I-III. Patients were randomized into Group 1 (n = 50) that included patients who underwent laryngoscopic examination using Macintosh laryngoscope or Endolarenx videolaryngoscope (Group 2: n = 50). Data on intubation time, glottic view (Cormack-Lehane grades), first-attempt success rate, need for anterior laryngeal pressure, and complications were collected.

Results: VL was associated with longer intubation time than DL (29.1±5.7 s vs. 20.7±5.1 s, P=0.001). Glottic visualization was better in the VL group (Cormack-Lehane Grade 1: 78% vs. 66%), but first-attempt success rate was lower (74% vs. 98%, P < 0.001). The need for anterior laryngeal pressure was significantly reduced in VL (32% vs. 78%, P=0.01). No complications, such as trauma or hypoxaemia, were observed in either group.

Conclusion: VL improves glottic visualization and reduces the need for airway maneuvers but is associated with longer intubation times and lower first-attempt success. While DL may be more efficient for routine intubation, VL remains valuable in anticipated or emergent difficult airway situations.