Comparison of C-MAC Videolaryngoscope and Macintosh Laryngoscope for Ease of Double-Lumen Tube Insertion in Patients Undergoing Elective Thoracic Surgeries: A Prospective Randomized Controlled Study

Abstract

Background: Double-lumen tube placement is the gold standard for lung isolation during elective thoracic surgery but is technically more challenging than single-lumen intubation due to its larger size and rotational requirements. The C-MAC videolaryngoscope may improve glottic visualization and facilitate easier DLT (Double-Lumen Tube) insertion compared with the conventional Macintosh laryngoscope.

Methods: A prospective randomized controlled study was conducted among patients undergoing elective thoracic surgeries requiring DLT insertion. Participants were randomly allocated to either the C-MAC videolaryngoscope group or the Macintosh laryngoscope group. The primary outcomes included IDS (Intubation Difficulty Score), intubation time, first-pass success rate, and overall success rate. Secondary outcomes were hemodynamic responses (heart rate, systolic and diastolic blood pressure, and mean arterial pressure) and airway-related complications, including mucosal trauma, sore throat, and hoarseness.

Results: The C-MAC videolaryngoscope demonstrated superior intubation performance compared with the Macintosh laryngoscope. First-pass success was significantly higher with C-MAC (93.8%) than with Macintosh (75.0%; p=0.039). Overall success was 100% with C-MAC compared with 93.8% with Macintosh. C-MAC was associated with lower intubation difficulty, shorter intubation time, improved glottic visualization, fewer intubation attempts, reduced need for optimization maneuvers, and fewer airway-related complications. Hemodynamic responses were also more favourable with C-MAC during DLT insertion.

Conclusion: The C-MAC videolaryngoscope offers significant advantages over the conventional Macintosh laryngoscope for DLT insertion during elective thoracic surgery. Its higher first-pass success, reduced intubation difficulty, shorter intubation time, improved glottic visualization, and lower complication rates make it a reliable and effective device for thoracic airway management.