Comparison of Video Laryngoscopy versus Direct Laryngoscopy during Elective Endotracheal Intubation at Orotta and Halibet National Referral Hospitals Asmara, Eritrea 2022

Author(s): Betiel Yihdego Kidanemariam, Micheal Beraki Mengistu, Biniam Rezene, Hermon Teklebrhan Abraha, Mustofa Abdel Bari, Omer Osman, Samuel Fikremariam, Henok Afewerki Kidane

Introduction: Airway management plays an essential role in anesthesia during elective and emergency situations. Despite the necessity of extensive training and personal skills, direct laryngoscope stays the most widely used method of intubation. Video laryngoscope provides a better visualization of the airway, ease of use and short learning curve. However, with all its advantages, Video laryngoscope was less used as routine practice.

Aim: The aim of the study was to compare C- MAC video laryngoscope and direct laryngoscope during endotracheal intubation in Orotta and Halibet National Referral Hospitals. Methods: This was an interventional comparative study conducted between November and February 2022. Patients undergoing elective surgery were randomly allocated to one of two Groups comprising of 48 patients in each as: Group I direct laryngoscope and Group II video laryngoscope. Time of intubation, hemodynamic changes, ease of intubation, oesophageal intubation, airway trauma and postoperative throat pain were assessed after patients were intubated in each group. Descriptive statistics for demographic data, Pearson’s chi-square test, Fisher’s exact test, independent samples t-test or Mann-Whitney U were computed. Factors affecting first attempt success was determined using logistic regression.

Results: The overall mean age of the patients was 48.7 (14.09). The median time of intubation under DL (Md=40 seconds, IQR=24 seconds) was significantly greater (P<0.01) as compared to VL (Md= 28 seconds, IQR =17 seconds). Post-operative throat pain was high in DL group in comparison VL group with statistical significance (p=0.001). VL reduced the esophageal intubation rate from 14.6 % with DL to 0% (P = 0.012) but there was no difference in hemodynamic changes. The results also revealed at bivariate logistic regression that duration of intubation (p=0.006), ease of intubation (p=0.001), and Cormack Lehane grade (p<0.001) were significant determinants of first attempt success during video laryngoscope.

Conclusion: use of video laryngoscope improves duration of intubation, reduces postoperative throat pain and esophageal intubation. Nevertheless, there was no differences on first attempt success. Video laryngoscope proves to be superior.