Comparative analysis of c-mac video laryngoscopy and macintosh laryngoscopy for optimal glottic visualization in adult patients undergoing orthopedic surgery.

Abstract

Objective: To determine the visualization of the glottis using C-MAC videolaryngoscopy and Macintosh laryngoscopy in adult patients undergoing elective orthopedic surgery. Study Design: Randomized Controlled Trial. Setting: Ghurki Trust Teaching Hospital, Lahore. Period: 01-01-2026 to 31-03-2026. Methods: One hundred and forty-six patients (ASA I-II) aged 18-45 years and having no predictors of challenging airways were recruited and assigned randomly to two groups: Macintosh laryngoscopy (Group A, n=73) and C-MAC videolaryngoscopy (Group B, n=73). Intraoperative evaluation of glottic visualization was carried out with the Cormack-Lehane grading system. The SPSS version 23 was used to analyze data, and the p-value below 0.05 was discussed as statistically significant. Results: Macintosh group (45.2) versus videolaryngoscopy group (87.7): Good glottic visualization (CormackLehane Grade I2) was found in 45.2 percent of patients versus 87.7 percent of patients. The poor visualization (Grade III-IV) was found in 54.8% of the patients in the Macintosh group and 12.3% in the videolaryngoscopy group. 5.5 percent of the patients in the Macintosh group had immediate post-intubation complications and none in the videolaryngoscopy group. Conclusion: C-MAC videolaryngoscopy is associated with much better glottic visualization and a superior safety profile than Macintosh laryngoscopy. It can be regarded as a better option in the daily airway management, even in patients with no expected problematic airway.