A comparative study of hemodynamic response following laryngoscopy and endotracheal intubation with direct Macintosh laryngoscope versus D-blade video laryngoscope intubation in patients undergoing general anesthesia

Abstract

Background: Laryngoscopy forms a crucial part of general anesthesia in obtaining a good visualization of the vocal cords for the facilitation of smooth endotracheal intubation. Direct laryngoscope visualization using Macintosh laryngoscope is best seen in the sniffing position. The recent generation C-MAC video laryngoscope poses a special D blade with greater curvature to facilitate intubation. Aim and Objective: The primary objective of our study was to compare the hemodynamic responses during laryngoscopy and endotracheal intubation between Macintosh laryngoscopes and C-MAC D-blade video laryngoscopes. The secondary objective was focused on the duration of laryngoscopy, duration of intubation, total duration of intubation, and ease of intubation. Material and Methods: Our study was a prospective randomized single-blinded study and is grouped as Group M (Direct laryngoscope group) and Group V (Video laryngoscope group). The randomization was done by computer-generated method and the differences between the groups were statistically analyzed with the Independent t-test for continuous variables and Pearson’s chi-square test for categorical variables. Results: The hemodynamic stress response to laryngoscopy and intubation was less marked with D blade video laryngoscope when compared to Macintosh blade with statistical significance at 1 and 3 minutes (p=0.000 and 0.02 respectively) following tracheal intubation. Duration of laryngoscopy and intubation was lesser with D-blade video laryngoscope (p=0.0001 and 0.01 respectively). Better glottic visualization with minimal required extra lifting force and slight external laryngeal manipulations was noted in D blade video laryngoscope. Conclusion: The D-blade video laryngoscope showed less hemodynamic response to endotracheal intubation along with better visualization of the glottis, less external laryngeal manipulation, and identical IDS score when compared to macintosh laryngoscope in general anesthesia for elective surgeries.