Suspected or diagnosed cervical injury mandates manual in line stabilization and can present as a difficult airway. The D-blade video laryngoscopy is designed for better functionality and performance as the scopist can see “around the corner” and has definitive role in difficult airway management. Traditional direct laryngoscopy Macintosh 3 or 4 was compared to C-MAC D blade video laryngoscopy.

This study was conducted in Neurosurgical OT of CARE hospitals, Banjara hills, Hyderabad. 100 adult patients of ASA grade I&II were randomized using closed envelope method and allotted two techniques of intubation(direct Vs D-blade video laryngoscopy) with manual in line stabilization. Cormack-Lehane grading , time taken for successful intubation, number of attempts and haemodynamic response(heart rate, blood pressure) measured and ANOVA analysis was done to assess any differences between the two groups.

Cormack Lehane grade I view obtained in all 50 patients undergoing D-blade laryngoscopy compared to 20 patients undergoing routine MaCintosh direct laryngoscopy.(P<0.05).Number of attempts and time for intubation were not significantly different. There was a 15% increase in heart rate and mean arterial pressure in 75% of the patients undergoing direct laryngoscopy versus similar increase in the heart rate and blood pressure is only 5% in D-blade video laryngoscopy group. This difference is statistically different.

In a difficulty airway situation improved glottic visualization has a major impact on degree of airway manipulation, number of attempts, duration of laryngoscopy and success rate. Minimal manipulation and absence of the classic “upward and outward force” may attenuate pressor response too .

1)In this study, simulation of difficult airway by manual in line stabilization demonstrated a stable haemodynamic profile in patients undergoing D-blade laryngoscopy compared to direct laryngoscopy. 2) higher grade of Glottic visualization (grade I) was obtained in all patients randomized to C-MAC D-blade video laryngoscopy group compared to conventional MaCintosh direct laryngoscopy.