INCIDENCE OF DIFFICULT AIRWAY IN ELECTIVE SURGERIES USING VIDEO LARYNGOSCOPY VS DIRECT

Abstract

Background: Management of the airway is a critical component of anesthesia practice. Difficult airway increases the risk of hypoxia, airway trauma, and perioperative complications. Video laryngoscopy (VL) is a modern alternative to direct laryngoscopy (DL) and may improve visualization, reduce failed intubations, and lower the incidence of difficult airway. Objective: To compare the incidence of difficult airway in elective surgeries using video laryngoscopy versus direct laryngoscopy. Methodology: This comparative cross-sectional study was conducted at the Department of Anesthesiology, Hayatabad Medical Complex, Peshawar, Pakistan, over six months. A total of 210 patients undergoing elective surgery under general anesthesia were included and divided into two groups: VL group (n=105) and DL group (n=105). Patients aged 18–60 years, ASA I–II, and who provided informed consent were included. Patients with known airway anomalies, trauma, or emergency surgery were excluded. Airway assessment included Mallampati score, thyromental distance, and mouth opening. The primary outcome was incidence of difficult airway (Cormack-Lehane grade III/IV, multiple intubation attempts, or need for adjuncts). Data were analyzed using SPSS; chi-square test was applied for categorical variables and t-test for quantitative variables. A p-value ≤ 0.05 was considered significant. Results: Age and gender distribution were comparable between groups. The incidence of difficult airway was significantly lower in the VL group (7.6%) compared to the DL group (19.0%; p = 0.01). Cormack-Lehane grade III/IV was less frequent with VL (8% vs 21%). Mean intubation time was slightly higher for VL (25 ± 6 sec) versus DL (22 ± 5 sec; p = 0.02). Fewer adjuncts were required in the VL group (5% vs 15%; p = 0.01). Conclusion: Video laryngoscopy significantly reduces the incidence of difficult airway compared to direct laryngoscopy, provides better glottic visualization, and lowers the need for adjunct airway devices. VL should be considered a preferred tool for elective airway management in patients at risk of difficult intubation.