Videolaryngoscopy versus direct laryngoscopy for pediatric endotracheal intubation in tonsillectomy

Abstract

Background: Video laryngoscopes (VL) enhance glottic visualization and facilitate endotracheal intubation. While VL have demonstrated superiority over direct laryngoscopy (DL) in adults, evidence in pediatric populations remains limited. This study compared the performance and safety of the video laryngoscopy (VL) and direct laryngoscopy (DL) in pediatric endotracheal intubation.

Methods: In this randomized controlled trial, 180 children (aged 2–16 years) undergoing tonsillectomy under general anesthesia were assigned to intubation with either a McGRATH MAC VL or a MacIntosh DL. Primary outcome was the first-attempt intubation success rate. Secondary outcomes included intubation time, Cormack-Lehane grade, Intubation Difficulty Scale (IDS), external laryngeal manipulation (ELM) use, and complications.

Results: The VL group showed a higher first-attempt success rate than the DL group (95.6% vs. 84.4%; p=0.027). Time to intubation was similar (VL: 30.6 ± 5.7 s vs. DL: 28.4 ± 8.5 s; p=0.076). Grade I–II glottic views were more frequent with VL (97.8% vs. 85.6%; P = 0.003). The VL group had lower IDS scores, fewer ELMs, and fewer minor complications. Hemodynamic stability was maintained in both groups.

Conclusion: VL using McGRATH MAC improved intubation success and reduced airway-related complications compared to DL in pediatric tonsillectomy.

Keywords: Direct laryngoscopy; Endotracheal intubation; Pediatric; Tonsillectomy, Video laryngoscope

Citation: Van MN, Phan T, Xuan TT, Cong PM, Diemunsch P. Videolaryngoscopy versus direct laryngoscopy for pediatric endotracheal intubation in tonsillectomy. Anaesth. pain intensive care 2026;30(6):697-703. DOI: 10.35975/apic.v30i6.2794

Received: September 17, 2025; Revised: March 04; March 11, 2026; Accepted: March 11, 2026