A Randomized Control Study to Compare Hemodynamic Responses Between the Direct Laryngoscopy and the Intubating Laryngeal Mask Airway at the Tertiary Care Centre

Background: Direct laryngoscopy with the Macintosh laryngoscope is the standard technique for endotracheal intubation during general anaesthesia. However, laryngoscopy and intubation can provoke sympathetic stimulation leading to tachycardia and hypertension. The Intubating Laryngeal Mask Airway (ILMA) is an alternative airway device that allows ventilation and blind tracheal intubation without direct laryngoscopy. Objective: To compare the hemodynamic responses and intubation characteristics of tracheal intubation using direct laryngoscopy and ILMA in patients undergoing elective surgery under general anaesthesia. Methods: This prospective randomized comparative study included 110 adult patients aged 18–65 years with ASA physical status I–II scheduled for elective surgery under general anaesthesia. Patients were randomly divided into two groups of 55 each: Group M underwent intubation using direct laryngoscopy with Macintosh blade, and Group I underwent intubation using ILMA. Hemodynamic parameters including heart rate, systolic blood pressure, diastolic blood pressure, and mean arterial pressure were recorded at baseline, before intubation, during intubation, and at 1, 2, 5, and 10 minutes after intubation. Intubation time, success rate, and complications were also assessed. Results: The mean intubation time was significantly shorter in Group M compared with Group I (p < 0.05). The first-attempt success rate was higher in Group M, although the overall success rate was 100% in both groups. Hemodynamic parameters showed transient increases during intubation in both groups without significant differences. Conclusion: Direct laryngoscopy provides faster tracheal intubation with a higher first-attempt success rate, while ILMA offers comparable hemodynamic stability and can be considered a feasible alternative airway device.