Comparative Efficacy of Videolaryngoscopy and Direct Laryngoscopy in Patients Living With Obesity: A Meta-Analysis

Intubation in patients living with obesity poses unique challenges due to altered airway anatomy and reduced physiological reserve, increasing the risk of complications. In synthesizing evidence from multiple trials, our meta-analysis suggests that videolaryngoscopy may provide a higher likelihood of achieving successful intubation on the first attempt compared to direct laryngoscopy while not substantially increasing the procedure time. Videolaryngoscopy was associated with a significant increase in first-pass intubation success compared to direct laryngoscopy, with a pooled risk ratio (RR) of 0.42 (95% CI 0.22 - 0.78, p = 0.0064). There was no significant difference in time to intubation between the two techniques (standardised mean differences (SMD) 0.13, 95% CI -0.26 to 0.52, p = 0.51), a result approached with low certainty due to the high heterogeneity among studies. Although the underlying studies varied in their methods and patient populations, these findings support the consideration of videolaryngoscopy as a potentially more reliable and safer technique for airway management in patients with obesity.