This clinical study is designed to compare two different techniques used for inserting a breathing tube (a process known as intubation) in adult patients undergoing thyroid surgery who are predicted to have a difficult airway. A difficult airway refers to a situation where it may be challenging to place the breathing tube due to specific anatomical or physical factors such as restricted neck movement, enlarged thyroid gland (goiter), reduced mouth opening, short neck, or increased soft tissue around the neck. The two techniques being assessed are conventional direct laryngoscopy, which is the traditional method requiring neck extension for a direct view of the windpipe, and video laryngoscopy, a modern approach that uses a camera to visualize the vocal cords on a screen with less need for neck manipulation.

In this randomized controlled trial, a total of 60 patients meeting the eligibility criteria will be included and randomly assigned into two equal groups. One group will undergo intubation using the conventional laryngoscope, while the other group will be intubated using the video laryngoscope. The primary aim of this research is to evaluate which method provides a higher success rate of placing the endotracheal tube correctly on the first attempt. Additional outcomes that will be assessed include the total time taken for intubation, whether the intubation was ultimately successful regardless of the number of attempts, and the occurrence of any immediate injuries within the mouth or throat area during or after the procedure.

The underlying hypothesis of the study is that video laryngoscopy will result in a significantly higher first-attempt intubation success rate as compared to conventional laryngoscopy in patients with predicted difficult airways. This study intends to provide clinically useful evidence to guide anesthesiologists in selecting the most effective and safe intubation technique for patients undergoing thyroid surgery, with the goal of minimizing complications and improving procedural outcomes.

Inclusion Criteria:

• Age from 18 to 60 years
• Both genders will be included
• Patients requiring endotracheal intubation under general anaesthesia for thyroid surgery.
• Patients with anticipated difficult intubation based on the preoperative airway assessment.
• Patients having ASA (American College of Anaesthesiologists) class 1 to 2.

Exclusion Criteria:

• Patients having neck injury
• Patients having cervical spondylopathy
• Patients requiring urgent/ emergency thyroid surgery
• Patients with existing oropharyngeal or laryngeal abnormalities.
• Patients with a history of severe cardiovascular or respiratory diseases.