Comparison of Success & Complications Involved in Video Laryngoscopic, Bougie Guided Verses Preformed Endotracheal Tube Intubation

Background: Anticipated difficult airway management remains a major challenge in anesthetic practice. Video laryngoscopy has improved glottic visualization; however, successful endotracheal tube delivery remains difficult in many cases. Bougie-guided and preformed endotracheal tube techniques are commonly used adjuncts, but evidence comparing their effectiveness under video laryngoscopic guidance is limited. Material and Methods: This prospective interventional study was conducted in the Department of Anaesthesiology at Dr. D. Y. Patil Hospital and Research Centre over a period of two years. Sixty adult patients with anticipated difficult airways were randomly allocated into two groups: Group A underwent bougie-guided video laryngoscopic intubation, while Group B underwent preformed endotracheal tube-guided video laryngoscopic intubation (30 patients each). Primary outcomes included first-pass success rate, duration of intubation, and overall intubation success. Secondary outcomes included number of attempts, airway trauma, hemodynamic response, oxygen saturation, external laryngeal manipulation, and peri-intubation complications. Results: Baseline demographic and airway characteristics were comparable between groups. The bougie group demonstrated significantly shorter intubation time (37.77 ± 4.76 vs. 43.00 ± 4.02 seconds; p<0.001), higher first-pass success rate (90.0% vs. 63.3%; p=0.0184), fewer intubation attempts, greater rapid intubation success (<40 seconds; p<0.001), and higher overall intubation success (p=0.0326). Airway trauma occurred less frequently in the bougie group (2 vs. 7 patients). Post-intubation tachycardia was significantly lower with bougie-guided intubation (p=0.0284). Oxygen saturation and blood pressure responses were comparable between groups. Conclusion: Video laryngoscopic bougie-guided intubation is superior to preformed endotracheal tube intubation in anticipated difficult airway management, offering higher first-pass and overall success rates, shorter intubation times, fewer attempts, reduced airway trauma, and fewer complications. It represents a safer and more efficient technique for difficult airway management.

Keywords: Difficult airway, Video laryngoscopy, Bougie-guided intubation, Endotracheal tube, First-pass success, Airway trauma.