Comparison of success of intubation and laryngeal morbidity in Bougie versus Wire guided intubation

On the day prior to surgery routinepreanesthetic examination with airway assessment will be done. All patientswill any one or more marker of difficult airway like Modified mallampatti score2 or more or mild terminal neck restriction will be taken up for the study. Afterwritten informed consent routine premedication will be given. In the operatingtheatre after attaching standard ASA monitors patients will be positioned insniffing position using a pillow. Following preoxygenation intravenousinduction will be done using fentanyl 2mcg/kg,thiopentone 4-5 mg/kg.Endotracheal intubation will be facilitated using vecuronium 0.1mg/kg andfollowing ventilation with 100% oxygen and sevoflurane for 3 minuteslaryngoscopy will be done. On laryngoscopy the Cormack lehane grade will berecorded and only if it is grade 2 or more the anesthesiologist will intubatewith either bougie or guidewire depending upon the random allocation intoeither of the two groups. In the first group (BG) bougie will be passed throughglottis, scope removed and tube railroaded over it. In the second group (WG)guidewire will be passed through glottis, scope removed and tube railroadedover it. In both the groups time taken for intubation, hemodynamic parametersduring intubation, successful intubation in first attempt  and manipulation needed while railroading thetube will be noted. If intubation fails with either of the two techniquesvideolaryngoscope guided intubation will be done and it will be taken as afailure. In the post operative period within 12 hours of surgery patients willbe assessed by an ENT surgeon using telelaryngoscopy for any laryngealmorbidity and questioned regarding any hoarseness of voice or sore throat orvoice changes.