A Comparative Review of Hemodynamic Responses to Direct and Video Laryngoscopy: A Systematic Review

Background: Airway management is a crucial aspect of anesthesia and emergency medicine, with laryngoscopy being the primary technique for endotracheal intubation. Traditional direct laryngoscopy (DL) has long been used for this purpose, but video laryngoscopy (VL) has gained popularity due to its potential advantages, particularly in improving visualization and reducing the risk of complications. This review aims to compare the hemodynamic responses associated with DL and VL, focusing on their impact on cardiovascular parameters during intubation. Materials and Methods: A systematic review was conducted in accordance with PRISMA guidelines. Major databases, including PubMed, Scopus, and Ovid, were searched for randomized controlled trials (RCTs) published between ۲۰۲۱ and ۲۰۲۵. The search used the keywords "Direct Laryngoscopy," "Video Laryngoscopy," "Hemodynamic Response," and "Airway Management." In total, [insert number] articles were identified. From these, clinical trials were selected if they met the following criteria: published in English, assessed heart rate, blood pressure, and other cardiovascular indicators during or after intubation, used tools such as the Bispectral Index (BIS) to monitor anesthesia depth, and evaluated delirium using standardized methods like the Confusion Assessment Method (CAM). Results: The analysis of clinical trials indicates that video laryngoscopy tends to result in a smaller increase in heart rate and blood pressure compared to direct laryngoscopy. In particular, VL demonstrated a more stable hemodynamic profile in patients with challenging airways or those undergoing difficult intubations. Although some studies reported no significant differences, the majority favored VL for minimizing the stress response during the procedure. Additionally, VL was associated with a reduced need for multiple attempts at intubation, contributing to a less pronounced hemodynamic disturbance. Conclusion: Clinical trial evidence suggests that video laryngoscopy may provide hemodynamic advantages over direct laryngoscopy, especially in terms of reducing cardiovascular stress during intubation. Despite these findings, further high-quality, large-scale trials are needed to confirm these results across a broader range of patient populations and clinical conditions. Clinicians should incorporate patient-specific factors and airway difficulty when choosing the appropriate laryngoscopic technique.

کلیدواژه ها:

Direct Laryngoscopy ، Video Laryngoscopy ، Hemodynamic Response ، Airway Management