Background: Video laryngoscopy can manage predicted difficult airway as ordinary Macintosh laryngoscopy rather it does not require a line of sight to do the procedure. Objective: The aim of this randomized clinical trial was to compare between video assisted laryngoscope and conventional Macintosh laryngoscope in management of predicted difficult airway. Patients and Methods: Our study included sixty-six patients with predicted difficult airway prepared for elective minor surgery under general anesthesia. Patients were divided randomly into two equal groups; Group V: The video laryngoscope was used. Group M: a Macintosh laryngoscope was used. Laryngoscopic and intubation time were recorded as well as number of intubations attempts and failure rate. Additionally, Heart rate (HR) and oxygen saturation were recorded at different time intervals (baseline value, before intubation, at laryngoscopic time and at intubation time). Also, complications during intubation were recorded as hypoxemia <90 %, dental trauma and lip, gum and oral trauma. Results: Video laryngoscope group was significantly longer regard laryngoscopy time and intubation time comparing to direct Macintosh group. Patients of direct Macintosh group had higher HR during laryngoscopy time and during intubation time. Oxygen saturation during intubation time was significantly lower among direct Macintosh group. Video laryngoscope group was significantly associated with less attempts, but failure rate was significantly higher among direct Macintosh group compared to video laryngoscope group. Conclusion: Using video assisted laryngoscope in anticipated difficult intubated patients improves the quality of tracheal intubation and gives the best glottic view, but with longer laryngoscopic and intubation time.