A Novel Score for Procedural Difficulty During Videolaryngoscopic Intubation

Videolaryngoscopy generally improves the glottic view compared with direct laryngoscopy, yet a good view does not always translate into easy delivery of the tracheal tube. Existing classifications describe either the laryngeal view (Cormack-Lehane grade, percentage of glottic opening) or the overall difficulty of intubation (Intubation Difficulty Scale), but none characterizes which specific mechanism produces difficulty during videolaryngoscopic intubation. This observational study evaluates a component-based score developed to describe procedural difficulty encountered during videolaryngoscopic tracheal intubation. The score comprises four components, each graded 0 to 2 (total range 0 to 8): view-tube concordance, restricted epiglottic movement, need for additional laryngoscopic manoeuvres, and need for tube-shaping adjustment. Adult patients undergoing elective surgery under general anaesthesia with tracheal intubation performed using a Macintosh-blade videolaryngoscope were assessed. The primary objective is to examine the association between the total score and procedural outcomes: intubation time, number of attempts, and first-attempt success. Secondary objectives include the relationship of the score with the Intubation Difficulty Scale, the Video Classification of Intubation, percentage of glottic opening, preoperative airway assessment parameters and operator experience.

Inclusion Criteria: * Age 18 years or older * Elective surgery under general anaesthesia requiring tracheal intubation * Tracheal intubation planned with a Macintosh-blade videolaryngoscope Exclusion Criteria: * Age under 18 years * Planned awake intubation or a planned alternative primary airway technique (flexible bronchoscopic intubation, supraglottic airway as the definitive airway) * Tracheal intubation performed outside the operating theatre