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Abstract

Background: Airway obstruction and failed tracheal intubation are major contributors to morbidity and mortality in surgical and critical care settings. Orotracheal intubation remains a cornerstone of airway management in both elective and emergency situations. Among various video laryngoscopes (VLs), the McGrath and C-MAC devices are widely used, but comparative data on their performance remains inconclusive from Pakistan. Aim: To compare the efficacy of McGrath and C-MAC video laryngoscopes in adult patients undergoing elective orotracheal intubation. Methodology: This single-center, randomized controlled trial was conducted in the Doctors Hospital and Medical Centre, Lahore from 20 March 2025 to 20 June 2025. Patients were classified as American Society of Anesthesiologists (ASA) physical status I to IV, and scheduled for elective surgery requiring orotracheal intubation. Patients were randomly allocated to either the McGrath group (n = 50) or the C-MAC group (n = 50). The intubation was performed using standardized induction protocols. Primary outcome was the first-pass intubation success rate. Secondary outcomes included number of attempts, glottic view, ease of intubation, hemodynamic responses, and occurrence of complications. Data were analyzed using SPSS version 28.0 (IBM Corp), with significance set at p < 0.05. Results: First-attempt success was significantly higher in the C-MAC group (92%) compared to the McGrath group (70%) (p = 0.006). Ease of intubation was also superior in the C-MAC group, with 86% of cases rated as ≥8 on the NRS versus 60% in the McGrath group (p = 0.003). Although overall success rates (C-MAC 98%, McGrath 92%) and complications (C-MAC 2%, McGrath 10%) differed, these were not statistically significant. Glottic visualization was marginally better with the C-MAC (Grade 1 view in 88% vs. 80%), but the difference was not significant (p = 0.218). Hemodynamic parameters remained within safe ranges in both groups, with no significant intergroup variation. Conclusion: it demonstrated that the C-MAC video laryngoscope is associated with a significantly higher first-pass intubation success rate and greater ease of intubation compared to the McGrath in adult patients undergoing elective orotracheal intubation. Further research is warranted to assess their performance in difficult airway and emergency settings.