Comparison of Video Laryngoscopy Versus Conventional Laryngoscopy in Anticipated Difficult Intubation in Patients Undergoing Thyroid Surgery: Video Laryngoscopy Versus Conventional Laryngoscopy in Anticipated Difficult Intubation

Umaima Riaz; Zeeshan Majeed; Sairah Sadaf; Adeel Ahmed; Farah Abbas; Muhammad Irfan Jamil

doi:10.54393/pjhs.v7i6.3692

Authors

Umaima Riaz Department of Anesthesia and Intensive Care Unit, Sheikh Zayed Hospital, Rahim Yar Khan, Pakistan
Zeeshan Majeed Department of Health and Population, Maryam Nawaz Health Clinic, Rahim Yar Khan, Pakistan
Sairah Sadaf Department of Anesthesia and Intensive Care Unit, Sheikh Zayed Hospital, Rahim Yar Khan, Pakistan
Adeel Ahmed Department of Anesthesia, Mayo Hospital, Lahore, Pakistan
Farah Abbas Department of Anesthesia and Intensive Care Unit, Sheikh Zayed Hospital, Rahim Yar Khan, Pakistan
Muhammad Irfan Jamil Department of Internal Medicine, Lahore General Hospital, Lahore, Pakistan

DOI:

https://doi.org/10.54393/pjhs.v7i6.3692

Keywords:

Anticipated Difficult Intubation, Video Laryngoscopy, Direct Laryngoscopy, Thyroid Surgery, Cormack–Lehane Grade

Abstract

Anticipated difficult airway in thyroid surgery is associated with failed intubation, hypoxia, and airway trauma, despite structured preoperative assessment. Objectives: To compare video laryngoscopy with conventional direct laryngoscopy in adult patients undergoing elective thyroid surgery with anticipated difficult intubation in terms of first- attempt and overall tracheal intubation success, glottic visualization, intubation time, and immediate oropharyngeal injury. Methods: A randomized controlled trial was conducted in the Department of Anesthesia, Sheikh Zayed Hospital, Rahim Yar Khan, from January 2025 to June 2025. Sixty patients (18–60 years) undergoing elective thyroidectomy with anticipated difficult intubation (ASA I–II, ≥1 airway predictor) were enrolled by non-probability consecutive sampling and randomized (1:1) to conventional laryngoscopy or video laryngoscopy. All intubations were performed by experienced anesthetists. Results: Among 60 randomized patients, baseline age (44.47 ± 7.66 vs 44.60 ± 8.02 years) and gender distribution (46.7 % vs 40.0 % males) were comparable between conventional and video- laryngoscopy groups. Video laryngoscopy improved Cormack–Lehane grade I view frequency (60.0% vs 13.3%, p=0.002) and increased first-attempt intubation success (93.3% vs 60.0%, p=0.002). Overall success was 100.0% with video laryngoscopy versus 93.3% with direct laryngoscopy (p=0.150). Mean intubation time was longer with video laryngoscopy (45.13 ± 8.38 vs 39.20 ± 9.83 seconds, p=0.015). Immediate oropharyngeal injury was numerically lower with video laryngoscopy (6.7% vs 20.0%, p=0.129). Conclusions: In anticipated difficult airways during thyroid surgery, video laryngoscopy significantly improved first-attempt intubation success and glottic visualization, while overall success remained similarly high in both groups.

References

Urang M, Basumatary J, Saikia A, Talukdar TK, Borgohain R. Intubation Challenges in Surgeries of Thyroid Swellings. Asian Journal of Medical Sciences. 2023 Sep; 14(9): 53-7. doi: 10.3126/ajms.v14i9.55535.

Putrawan IW and Widnyana IM. Difficult Airway Management in Severe Tracheal Deviation Due to Large Nodular Goiter: A Case Report. Journal of Social Research. 2025 Sep; 4(10): 2505-13. doi: 10.55324/josr.v4i9.2768.

Hansel J, Rogers AM, Lewis SR, Cook TM, Smith AF. Videolaryngoscopy versus Direct Laryngoscopy for Adults Undergoing Tracheal Intubation: A Cochrane Systematic Review and Meta-Analysis Update. British Journal of Anesthesia. 2022 Oct; 129(4): 612-23. doi: 10.1016/j.bja.2022.05.027.

Agón KA and Maldonado JF. Awake Intubation with Videolaryngoscopy and Ultrasound-Guided Percutaneous Tracheostomy in a Patient with Anaplastic Thyroid Cancer and Difficult Airway: A Case Report. Colombian Journal of Anesthesiology. 2018 Apr; 46(2): 159-63. doi: 10.1097/CJ9.0000000000000029.

Alwan I, Alwan M, Mahgoub I, Eghzawi A, Gharaibeh A, Goyal AV. Video Laryngoscopy Vs. Direct Laryngoscopy in Adult Patients with Difficult Airways Who Require Emergency Intubation. Emergency Care and Medicine. 2024 Apr; 1(2): 77-86. doi: 10.3390/ecm1020011.

Dardeer A, Alhammad MF, Zaza KJ, Shallik AN, Hammad YA, Elkarta ES et al. First-Pass Success in Video Laryngoscopy with Transcutaneous Infrared Illumination in Patients with Normal Airways–A Clinical Pilot Study. Journal of Clinical Monitoring and Computing. 2025 Sep: 1-9. doi: 10.1007/s10877-025-01361-4.

Vargas M, Pastore A, Aloj F, Laffey JG, Servillo G. A Comparison of Videolaryngoscopes for Tracheal Intubation in Predicted Difficult Airway: A Feasibility Study. BioMed Central Anesthesiology. 2017 Feb; 17(1): 25. doi: 10.1186/s12871-017-0318-2.

Khajavi M, Kazeroni R, Ramezani R, Biderafsh A, Kianpour P, Neishaboury M. Tracheal Intubation with Glidescope Vs. Sanyar Video Laryngoscopes in Adults with Predicted Difficult Intubation: A Non-Inferiority Clinical Trial. Anesthesiology Intensive Therapy. 2025 May; 57: e80. doi: 10.5114/ait/200292.

Bhattacharjee S, Maitra S, Baidya DK. A Comparison Between Video Laryngoscopy and Direct Laryngoscopy for Endotracheal Intubation in the Emergency Department: A Meta-Analysis of Randomized Controlled Trials. Journal Of Clinical Anesthesia. 2018 Jun; 47: 21-6. doi: 10.1016/j.jclinane.2018.03.006.

Kriege M, Hilt JA, Dette F, Wittenmeier E, Meuser R, Staubitz JI et al. Impact of Direct Laryngoscopy vs. Videolaryngoscopy on Signal Quality of Recurrent Laryngeal Nerve Monitoring in Thyroid Surgery: A Randomized Parallel Group Trial. Anesthesia. 2023 Jan; 78(1): 55-63. doi: 10.1111/anae.15865.

Liu L, Yue H, Li J. Comparison of Three Tracheal Intubation Techniques in Thyroid Tumor Patients with a Difficult Airway: A Randomized Controlled Trial. Medical Principles and Practice. 2014 Aug; 23(5): 448-52. doi: 10.1159/000364875.

Liu DX, Ye Y, Zhu YH, Li J, He HY, Dong L et al. Intubation of Non-Difficult Airways Using Video Laryngoscope versus Direct Laryngoscope: A Randomized, Parallel-Group Study. BioMed Central Anesthesiology. 2019 May; 19(1): 75. doi: 10.1186/s12871-019-0737-3.

Amaniti A, Papakonstantinou P, Gkinas D, Dalakakis I, Papapostolou E, Nikopoulou A et al. Comparison of Laryngoscopic Views Between C-MAC™ and Conventional Laryngoscopy in Patients with Multiple Preoperative Prognostic Criteria of Difficult Intubation. An Observational Cross-Sectional Study. Medicina. 2019 Nov; 55(12): 760. doi: 10.3390/medicina55120760.

Downey AW, Duggan LV, Law JA. A Systematic Review of Meta-Analyses Comparing Direct Laryngoscopy with Videolaryngoscopy. Canadian Journal of Anesthesia. 2021 May; 68(5): 706-14. doi: 10.1007/s12630-021-01921-7.

Mohammed AM, Abdel-Fatah AE, Abdul Latif HK, Farmawy MS. Study of Video Assisted Laryngoscope versus Conventional Macintosh Laryngoscope for Management of Predicted Difficult Airway in Minor Elective Surgeries. The Egyptian Journal of Hospital Medicine. 2022 Apr; 87(1): 1449-55. doi: 10.21608/ejhm.2022.225411.

Vargas M, Servillo G, Buonanno P, Iacovazzo C, Marra A, Putensen-Himmer G et al. Video vs. Direct Laryngoscopy for Adult Surgical and Intensive Care Unit Patients Requiring Tracheal Intubation: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. European Review for Medical and Pharmacological Sciences. 2021 Dec; 25(24).

Jungbauer A, Schumann M, Brunkhorst V, Börgers A, Groeben H. Expected Difficult Tracheal Intubation: A Prospective Comparison of Direct Laryngoscopy and Video Laryngoscopy in 200 Patients. British Journal of Anesthesia. 2009 Apr; 102(4): 546-50. doi: 10.1093/bja/aep013.

Polo PP, Ramirez-Rodriguez R, Alejandro-Salinas R, Yangali-Vicente J, Rivera-Lozada O, Barboza JJ. Video versus Direct Laryngoscopy for Tracheal Intubation of Critically Ill Adults: A Systematic Review and Meta-Analysis. Journal of Clinical Medicine. 2025 Mar; 14(6): 1933. doi: 10.3390/jcm14061933.

Taboada M, Fernández J, Bermúdez M, Estany‐Gestal A, Molins N, de los Ángeles Orallo M et al. Universal Videolaryngoscopy for Tracheal Intubation in the Operating Theatre: A Prospective Non‐Randomized Clinical Trial. Anesthesia. 2025 Sep; 80(9): 1045-56. doi: 10.1111/anae.16643.

Lewis SR, Butler AR, Parker J, Cook TM, Schofield-Robinson OJ, Smith AF. Videolaryngoscopy versus Direct Laryngoscopy for Adult Patients Requiring Tracheal Intubation: A Cochrane Systematic Review. BJA: British Journal of Anesthesia. 2017 Sep; 119(3): 369-83. doi: 10.1093/bja/aex228.