Application of Tracheal Intubation in Lateral Position in Thoracic Surgery

xiangming fang

Status: Completed

Conditions: Tracheal Intubation; Thoracic Surgery; Anesthesia

Treatments: Procedure: Intubation and bronchial blocker placement performed in lateral position

Study type: Interventional

Funder types: Other

Identifiers

NCT05482230

2015299

Details and patient eligibility

About

This study investigated the incidence of bronchial blocker malposition in the lateral versus supine position and evaluated the effectiveness of lateral placement.

Full description

Routine thoracic surgery anesthesia requires that endotracheal intubation be performed with the patient in the supine position; the patient subsequently needs to be placed in a lateral position through the cooperation of the anesthetist, theatre nurse, and surgeon. Achieving this change in position is time-consuming and likely to result in adverse events, such as loss of the anesthetic airway and arteriovenous catheter, hemodynamic fluctuations, and malposition of the BB which adversely affect anesthesia management and postoperative recovery. For patients with hypertensive heart disease, the risk of cardiovascular and cerebrovascular accidents increases during the perioperative period .

Therefore, we conducted a prospective, randomized, controlled, multi-center study to evaluate the ease, efficacy, and safety of video laryngoscopy-guided intubation and bronchial blocker placement performed in lateral position.

Enrollment: 306 patients

Sex: All

Ages: 18 to 80 years old

Volunteers: No Healthy Volunteers

Inclusion and exclusion criteria

The inclusion criteria :

• 80 Years<age ≥18 years;
• American Society of Anesthesiologists (ASA) physical status I-III;
• Undergo thoracic surgery requiring one-lung ventilation.

The exclusion criteria were:

• Risk of difficult intubation based on preoperative assessment (maximum mouth opening <3 cm, body mass index >30 kg/m2, limited neck movement, Mallampati grade IV, or main airway stenosis);
• Right upper bronchus originating at or above the tracheal carina;
• Plan to undergo bronchial sleeve resection, right upper lobectomy, or non-intubated thoracic surgery;
• Evidence or symptoms of acute lung or airway infection;
• History of thoracic surgery;
• Prior thoracic radiotherapy or chemotherapy;
• Preoperative upper extremity pain;
• Severe mental illness or difficulty with communication.

Trial design

Primary purpose: Supportive Care

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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306 participants in 2 patient groups

Intubation and bronchial blocker placement performed in lateral position

Experimental group

Description:

In the lateral position group, patients were positioned laterally (as required for surgery) before anesthesia induction. After anesthesia induction, both endotracheal intubation and bronchial blocker placement were performed while the patient remained in the lateral position.

Treatment:

Procedure: Intubation and bronchial blocker placement performed in lateral position

Intubation and bronchial blocker placement performed in supine position

No Intervention group

Description:

Intubation and the placement of a bronchial blocker are typically carried out with the patient in the supine position, which is a standard procedure in thoracic surgery.