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Purpose This study was designed to compare videolaryngoscopy with direct laryngoscopy with respect to ease of intubation when inserting a double lumen tube (DLT). Methods In this prospective randomized study 68 patients American Society of Anesthesiologists (ASA) physical status I and II were included. Patients with criteria indicating possible difficult intubation were excluded. The patients were randomized into two groups, depending on the tool used to facilitate intubation: videolaryngoscope (VL group) or direct laryngoscopy (DL group). The time required for intubation was the primary endpoint. Cormack and Lehane glottic visualization (CL) scores, the need for external laryngeal maneuvers and the number of attempts were measured. Results Glottic visualization was better in the VL group than in the DL group. The CL scores were I, II and III in 24, eight and two patients, respectively, in the VL group compared with 13, 11 and eight in the DL group (P = 0.025). Patients in the VL group required fewer attempts than the DL group (P = 0.019). Intubation time was 39.9 ± 4.4 sec in the VL group and 47.9 ± 5.4 sec in the DL group (P \ 0.001). No intubation failure was noted in group VL compared with two in the DL group (not significant). Conclusion The use of a videolaryngoscope reduces the time required for intubation with a DLT compared with the direct laryngoscopy in elective thoracic surgery.

The authors reported and discussed management a case of undiagnosed pheochromocytoma suspected because the catastrophic hemodynamic changes in a patient with an acute appendicitis.

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