Videolaryngoscopy versus flexible bronchoscopy for awake tracheal intubation in adults: an updated systematic review and meta-analysis of randomised controlled trials

A systematic review and meta-analysis of randomised controlled trials comparing videolaryngoscopy (or optical indirect rigid laryngoscopy) with flexible bronchoscopy for awake tracheal intubation in adults. The primary outcome is successful intubation at the first attempt with the allocated device; secondary outcomes include success within the attempts permitted by each trial, failure of the allocated technique, time to tracheal intubation, hypoxaemia, postoperative sore throat, oesophageal intubation, airway bleeding and patient-reported satisfaction or comfort. Databases searched were PubMed, Europe PMC, OpenAlex and ClinicalTrials.gov from inception to 26 September 2026, without language restrictions, supplemented by backward and forward citation searching. Risk of bias was assessed with RoB 2 and certainty of evidence with GRADE. This record is submitted retrospectively: the review was completed before registration, and no protocol was prospectively registered or published.