Research Article

Comparison of Truview® Video Laryngoscopy with Conventional Macintosh Direct Laryngoscopy for Orotracheal Intubation: A Randomized Controlled Trial


Background: Exaggerated hemodynamic response has been linked to laryngoscopy and intubation. This reaction might have negative consequences on the respiratory system, the nervous system, and the heart. It might show up as tachycardia, hypertension, and dysrhythmias. The oral, pharyngeal, and laryngeal axes, all need to be aligned, which is largely responsible for the laryngoscopy reaction. Hence video laryngoscope was developed to overcome this response which does not require the alignment of these three axes. Thus, it can provide this ameliorating effect with less suspension and distension force, which will probably result in less hemodynamic changes during laryngoscopy. Comparing the hemodynamic response during laryngoscopy and intubation using the conventional McIntosh direct laryngoscope and the Truview® video laryngoscope was the primary objective of this study. Intubation time and glottic opening using Cormack Lehane grade were the secondary objectives.
Methods: This randomized controlled trial was conducted in 60 patients who were scheduled to undergo elective surgeries requiring conventional GA. Random allocation into two groups was done. Patients in Group ML (n=30) underwent laryngoscopy and intubation using a conventional McIntosh laryngoscope. Patients in Group VL (n=30) underwent laryngoscopy and intubation using a Truview video laryngoscope. Before and after endotracheal intubation, as well as 2, 5, and 10 minutes later, both groups were monitored for changes in hemodynamic parameters such as heart rate, systolic and diastolic pressure, and mean arterial pressure. Intubation time and glottic view was also assessed using the Cormack Lehane grade.
Results: Heart rate, systolic blood pressure, mean arterial blood pressure, and intubation time were significantly different between the two groups (p=0.00). The diastolic blood pressure did not significantly differ between the two groups (p=0.203). There was no statistically significant correlation between the type of laryngoscopy and the glottic view with Cormack Lehane Grade favouring certain groups (p=1).
Conclusion: We conclude that tracheal intubation with Truview video laryngoscope is advantageous in preventing cardiovascular stress response but with longer intubation time.

[1] Reid LC, Brace DE. Irritation of respiratory tract and its reflex effect on heart- Surgery. Gynecology Obstetrics. 1940; 70:157.
[2] Derbyshire DR, Chmielewski A, Fell D, Vaters M, Achola K, Smith G. Plasma catecholamine response to tracheal intubation. Br J Anaesth 1983; 55:855-9.
[3] Fox EJ, Sklar GS, Hill CH, Villanue Var, King BD. Complications related to the presser response to endotracheal intubation. Anesthesiology. 1977; 47:524- 5.
[4] Karl. Insertion of LMA in place of endotracheal intubation to attenuate the cardiovascular response. IJA, 1999;43:30-35.
[5] Kumar. Blocking Glossopharyngeal & superior laryngeal nerves to attenuate the cardiovascular response to laryngoscopy & endotracheal intubation. IJA 1993; 41:20-25.
[6] Foregger R. Richard von Foregger, Ph.D., 1872-1960. Manufacturer of anaesthesia equipment. Anesthesiology. 1996; 84(1): 190 -200.
[7] Lee L, Weightman WM. Laryngoscopy force in the sniffing position compared to the extension-extension position. Anaesthesia. 2008; 63(4):375-8.
[8] Prakash S, Rapsang AG, Mahajan S, Bhattacharjee S, Singh R, Gogia AR. Comparative evaluation of the sniffing position with simple head extension for laryngoscopic view and intubation difficulty in adults undergoing elective surgery. Anesthesiol Res Pract. 2011; 2011:297913.
[9] Akhtar M, Ali Z, Hassan N, Mehdi S, Wani GM, Mir AH. A Randomized Study Comparing the Sniffing Position with Simple Head Extension for Glottis Visualization and Difficulty in Intubation during Direct Laryngoscopy. Anesth Essays Res. 2017; 11(3):762-766.
[10] El-Orbany M, Woehlck H, Salem MR. Head and neck position for direct laryngoscopy. Anesth Analg. 2011; 113(1):103-9.
[11] Hemanth Kumar VR, Janani N, Indubala M, Jaya V. Patient positioning and glottic visualization: A narrative review. Airway. 2020; 3(1):13-8.
[12] Mendonca C, Ungureanu N, Nowicka A, Kumar P. A randomised clinical trial comparing the 'sniffing' and neutral position using channelled (KingVision®) and non-channelled (C-MAC®) videolaryngoscopes. Anaesthesia. 2018; 73(7):847-855.
[13] Kaur G, Gupta S, Mehta N, Dhingra JS. Comparative Evaluation of McGrath MAC, Truview Video Laryngoscopes and Macintosh Laryngoscope for Endotracheal Intubation in Patients Undergoing Surgery under General Anaesthesia. Anesth Essays Res. 2020; 14(1):20-24.
[14] Gupta U, Jadhav V. A comparative study between Video-laryngoscopy (TrueView evo2) vs Conventional laryngoscopy (Macintosh) in adult patients with predicted difficult airway. MedPulse International Journal of Anesthesiology. 2020; 13(3): 196-201.
[15] Tempe DK, Chaudhary K, Diwakar A, Datt V, Virmani S, Tomar AS, et al. Comparison of hemodynamic responses to laryngoscopy and intubation with Truview PCD™, McGrath® and Macintosh laryngoscope in patients undergoing coronary artery bypass grafting: A randomized prospective study. Ann Card Anaesth. 2016; 19(1):68-75.
[16] Sarkılar G, Sargın M, Sarıtaş TB, Borazan H, Gök F, Kılıçaslan A, et al. Hemodynamic responses to endotracheal intubation performed with video and direct laryngoscopy in patients scheduled for major cardiac surgery. Int J Clin Exp Med. 2015; 8(7):11477-83.
[17] Bag SK, Kumar VR, Krishnaveni N, Ravishankar M, Velraj J, Aruloli M. A comparative study between Truview(PCD) laryngoscope and Macintosh laryngoscope in viewing glottic opening and ease of intubation: A crossover study. Anesth Essays Res. 2014; 8(3):372-6.
[18] Altun D, Ali A, Çamcı E, Özonur A, Seyhan TÖ. Haemodynamic Response to Four Different Laryngoscopes. Turk J Anaesthesiol Reanim. 2018; 46(6):434-440.
IssueVol 8 No Supplement (2022): Autumn QRcode
SectionResearch Article(s)
Truview videolaryngoscope Cormack lehane glottic opening Hemodynamic response

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
Ghodki P, Kulkarni P, Prabhu A, Dhamdhere A. Comparison of Truview® Video Laryngoscopy with Conventional Macintosh Direct Laryngoscopy for Orotracheal Intubation: A Randomized Controlled Trial. Arch Anesth & Crit Care. 2022;8(Supplement):370-376.