Optimizing Tracheal Intubation in Obese Patients: A Randomized Trial of Standard Vs. Flexible Tip Bougies with Hyperangulated Videolaryngoscope

Obese patients present unique airway management challenges due to altered anatomy, leading to increased risk of difficult intubation and peri-intubation complications. Hyperangulated videolaryngoscopes (VLs) like the C-MAC D-Blade enhance glottic visualization but make tube insertion more challenging. This prospective randomized trial aims to compare the effectiveness of standard bougie versus flexible-tip bougie for tracheal intubation using a C-MAC D-Blade in obese adults. After preoperative evaluation and informed consent, eligible patients will be randomised into two groups: Standard Bougie group and Flexible-Tip Bougie group. Following standard general anesthesia induction and neuromuscular blockade, intubation will be performed in the ramped position using the assigned bougie technique. An experienced anesthesiologist will conduct all intubations. The primary outcome is the modified Intubation Difficulty Scale (mIDS) score. Secondary outcomes include intubation time, number of attempts, first attempt success rate, optimization maneuvers, and complications such as desaturation or dental trauma. This trial seeks to identify which bougie provides greater ease and success during tracheal intubation in obese surgical patients, thereby contributing to evidence-based airway management strategies.