Comparing Hemodynamic Variability During Intubation Using Macintosh and Video Laryngoscopy in Difficult Airway

Abstract

Background: Hemodynamic alterations during intubation can significantly impact patient outcomes, especially in difficult airway scenarios, yet there is limited comparative research assessing the effects of Macintosh versus video laryngoscopy on these parameters in such patients. Objective: This study aimed to compare hemodynamic variability—including heart rate, blood pressure, mean arterial pressure, and oxygen saturation—during intubation using Macintosh and video laryngoscopes in patients with difficult airways, with the expectation that video laryngoscopy would offer greater cardiovascular stability. Methods: This prospective, comparative study included 100 adult patients (n=100) aged 20–70 years, scheduled for elective surgeries under general anesthesia at a tertiary care center, all with difficult airways defined as Mallampati class III or IV and ASA grade I–III. Patients were divided equally into Macintosh and video laryngoscope groups (n=50 each). Key exclusion criteria were age >70 years, Mallampati I–II, and significant cardiorespiratory comorbidities (ASA IV–VI). Hemodynamic parameters were assessed using standardized anesthesia monitors, and data were collected on a prestructured proforma. Statistical analysis was performed using SPSS v27, with paired t-tests and p≤0.05 indicating significance. The study adhered to the Declaration of Helsinki and received institutional ethical approval. Results: Video laryngoscopy was associated with significantly lower mean heart rate (mean difference = 0.48, p=0.003), blood pressure (mean difference = 1.18, p=0.002), mean arterial pressure (mean difference = 2.12, p<0.001), and higher SpO₂ levels (mean difference = 0.74, p<0.001) compared to the Macintosh group. Clinically, the video laryngoscope group experienced fewer episodes of tachycardia, hypertension, and oxygen desaturation, supporting greater hemodynamic stability during intubation. Conclusion: Video laryngoscopy confers superior hemodynamic stability over Macintosh laryngoscopy during intubation in patients with difficult airways, making it a preferred tool for airway management in such cases. Adoption of video laryngoscopy may enhance patient safety, optimize clinical outcomes, and should be prioritized in protocols for managing complex airway scenarios.