Hemodynamic Stability During Airway Instrumentation: Comparison of Direct Laryngoscopy, Videolaryngoscopy, and Laryngeal Mask Airway Techniques

Abstract

Airway instrumentation during the induction of general anesthesia is well known to provoke a sympathetic-mediated cardiovascular response characterized by transient increases in heart rate and arterial blood pressure. These hemodynamic changes may be clinically insignificant in healthy individuals but can pose substantial risks in patients with cardiovascular, cerebrovascular, or other systemic comorbidities. Therefore, selecting an airway management technique that minimizes the pressor response is of considerable clinical importance. This randomized controlled trial was conducted to compare the hemodynamic responses associated with direct laryngoscopy (DL), videolaryngoscopy (VL), and laryngeal mask airway (LMA) insertion in adult patients undergoing elective surgical procedures under general anesthesia. A total of 150 patients were enrolled and randomly assigned into three equal groups (n = 50 each) according to the airway management technique used. Heart rate (HR) and mean arterial pressure (MAP) were recorded at baseline, during airway instrumentation, and at 1, 3, and 5 minutes following the procedure. The collected data were analyzed using repeated-measures analysis of variance (ANOVA) to evaluate differences in hemodynamic responses over time among the study groups. The results demonstrated that all three airway management techniques produced a transient increase in HR and MAP following instrumentation. However, the magnitude of the response differed significantly among the groups, with direct laryngoscopy producing the greatest increase and LMA insertion resulting in the smallest hemodynamic disturbance (p < 0.001). Videolaryngoscopy showed an intermediate response, significantly attenuating the cardiovascular changes compared with direct laryngoscopy. These findings suggest that LMA insertion is associated with superior hemodynamic stability, while videolaryngoscopy offers a less pronounced pressor response than conventional direct laryngoscopy, supporting their use in patients vulnerable to adverse cardiovascular effects during airway management.