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

Abstract

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.