Video laryngoscope versus disposcope endoscope for anticipated laryngeal tumor related difficult intubation in patients undergoing general anesthesia: a randomized controlled trial

Laryngeal tumors can cause significant anatomical distortion, making tracheal intubation challenging. Compared to video laryngoscope (VL), intubation using a Disposcope endoscope (DE) offers flexibility and allows for better navigation around obstructive lesions in the upper airway. This study aimed to compare the clinical performance of DE and VL for anticipated laryngeal tumor related difficult intubation in Ear, Nose, and Throat (ENT) patients undergoing general anesthesia. We conducted a prospective, randomized, controlled trial. Eighty patients with anticipated difficult intubation due to laryngeal tumors undergoing elective surgery were included and randomly allocated to either the DE group (n = 40) or the VL group (n = 40). The primary outcome was the first-attempt success rate of tracheal intubation. Secondary outcomes included intubation time, hemodynamic response, and the incidence of complications related to intubation. A total of 80 subjects (61 male/19 female, 30 to 81 years old) were included in the final analysis. The first-attempt success rate of tracheal intubation was significantly higher in the DE group compared with the VL group (97.5% vs. 77.5%; mean difference [95% CI]: 20% [5.5 to 35.1]; P = 0.007). The intubation time was reduced in the DE group compared to the VL group (28.5 ± 6.7 s vs. 39.0 ± 10.0 s, mean difference [95% CI]: 10.5 s [6.7 to 14.3]; P < 0.001). Compared to DE, VL exhibited a higher heart rate one minute after intubation (71.1 ± 10.9 bpm vs. 78.3 ± 12.8 bpm; mean difference [95% CI]: 7.2 bpm [1.9 to 12.5]; P = 0.008). The incidence of postoperative airway complications was not significantly different between the two groups. The DE showed a higher first-attempt success rate and a shorter intubation time than the VL for anticipated laryngeal tumor related difficult intubation in ENT patients undergoing general anesthesia. Chinese Clinicaltrials Identifier: ChiCTR2300068449. Trial Registration Date: February 20, 2023. Date of enrolment of the first research participant: March 1, 2023. Chinese Clinical Trials Identifier ChiCTR2300068449.