Comparison of Video Laryngoscope to a Flexible Fiber-optic Bronchoscope for Intubation of Patients Undergoing Elective Cervical Spine Surgery with Cervical Immobilization: A Prospective Randomized Controlled Trial

BACKGROUND: Cervical spine injury patients often require airway management under conditions where neck movement must be minimized to prevent neurological deterioration. Conventional fiberoptic bronchoscopy (FOB) has long been considered the gold standard for such cases, but newer videolaryngoscopes (VDLs) are increasingly being evaluated as viable alternatives. OBJECTIVE: The objective of this study was to compare the efficacy and safety of VDL and fiberoptic bronchoscope for endotracheal intubation in patients undergoing elective cervical spine surgery under general anaesthesia. MATERIALS AND METHODS: This randomized, single-blinded, controlled trial included 30 patients (aged 18-65 years, American Society of Anesthesiologists I-II) scheduled for elective cervical spine fixation. Patients were randomized into two groups: Group A (VDL, n = 15) and Group B (FOB, n = 15). Primary outcomes were time taken for successful intubation and number of attempts. Secondary outcomes included hemodynamic responses (heart rate, mean arterial pressure), adverse events, and postoperative neurological deficits. RESULTS: VDL significantly reduced intubation time (17.6 ± 5.5 s vs. 42.6 ± 14.0 s, P < 0.001) and required fewer attempts compared to FOB (P = 0.028). Postintubation tachycardia was more pronounced in the FOB group (P < 0.0001), whereas mean arterial pressure changes were higher in FOB patients at 3 min postintubation (P = 0.0122). Adverse events and neurological deficits did not differ significantly between the groups (P > 0.05). CONCLUSION: VDL offers a safe and effective alternative to FOB in cervical spine surgery, with advantages of shorter intubation times, fewer attempts, and more stable haemodynamics. However, operator expertise remains an important factor influencing outcomes.