COMPARATIVE EVALUATION OF HEMODYNAMIC CHANGES DURING ENDOTRACHEAL INTUBATION USING MACINTOSH LARYNGOSCOPE VERSUS VIDEOLARYNGOSCOPE IN PATIENTS UNDERGOING ELECTIVE SURGERIES: A PROSPECTIVE RANDOMIZED CONTROLLED STUDY
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Keywords
Videolaryngoscopy, Macintosh laryngoscope, hemodynamic response, endotracheal intubation, elective surgery
Abstract
Laryngoscopy and endotracheal intubation trigger significant hemodynamic responses through sympathetic stimulation, potentially precipitating cardiovascular complications in susceptible patients. Videolaryngoscopes theoretically reduce tissue manipulation compared to conventional Macintosh laryngoscopy, potentially attenuating these responses. This study compared hemodynamic changes during intubation using Macintosh laryngoscope versus videolaryngoscope in patients undergoing elective surgeries.
Methods: A prospective randomized controlled study was conducted at JIET Medical College and Hospital, Jodhpur, over six months from January 2025 to June 2025. One hundred patients aged 18-65 years with ASA physical status I-II and predicted normal airways were randomly allocated to Macintosh (n=50) or videolaryngoscope (n=50) groups. Hemodynamic parameters including heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure, and rate-pressure product were recorded at baseline, pre-laryngoscopy, and at 0, 1, 3, and 5 minutes post-intubation. Intubation characteristics and complications were documented. Data were analyzed using independent t-tests and repeated measures ANOVA with significance at p<0.05.
Results: Groups were demographically comparable. Videolaryngoscope group demonstrated significantly lower heart rate (98.4±12.6 vs 108.6±14.2 beats/min, p<0.001), systolic blood pressure (152.6±16.8 vs 168.2±18.4 mmHg, p<0.001), and rate-pressure product (15.01±2.86 vs 18.26±3.42 ×10³, p<0.001) immediately post-intubation. These differences persisted through five minutes. Videolaryngoscopy required longer intubation time (18.8±6.2 vs 12.4±4.6 seconds, p<0.001) but provided superior glottic visualization and fewer complications.
Conclusion: Videolaryngoscopy produces significantly attenuated hemodynamic responses compared to Macintosh laryngoscopy during endotracheal intubation, with improved glottic visualization and favorable safety profile, supporting its consideration as preferred technique for patients at cardiovascular risk.
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Dr Praveen Kumar Gupta
Assistant Professor, Department of Anaesthesia, JIET Medical College and Hospital, Jodhpur
Dr. Priyanka Tetarwal
Senior Resident, Department of Anaesthesia, JIET Medical College and Hospital, Jodhpur
