Should videolaryngoscopy enter routine use? Unanticipated difficult airway: A five-year experience in a tertiary care hospital

Abstract

Aim: An unanticipated difficult airway (UDA) can be very challenging for anesthesiologists in airway management and, if not managed appropriately, may lead to increased morbidity and even mortality in patients. Because patients with normal physical examination findings may also have a difficult airway, meticulous preparations are essential for every patient. Our study investigated the five-year outcomes of a tertiary care hospital in patients with UDA.

Materials and Methods: We retrospectively reviewed the records of 143 patients with UDA who underwent surgery under general anesthesia between January 2020 and March 2025. We evaluated their airway management: preoperative physical examination findings, demographics, comorbidities, mask ventilation, laryngoscopic visualization, and tracheal intubation success.

Results: We found that videolaryngoscopy (VL) improved glottic visualization compared to direct laryngoscopy (DL) in patients with UDA (p<0.001). VL reduced the risk of complications and accidental esophageal intubation compared to DL (p<0.001, p<0.001, respectively). We also found that 129 out of 133 patients (97%) who could not be intubated with DL were successfully intubated endotracheally using VL.

Conclusion: VL improves glottic visualization, reduces the risk of complications, and increases the rate of successful intubation compared to DL in patients with UDA.