Endotracheal intubation under video laryngoscopic guidance during upper gastrointestinal endoscopic surgery in the left lateral position: A randomized controlled trial

Yue Jin, Jing Ying, Kai Zhang, Xiangming Fang, Yue Jin, Jing Ying, Kai Zhang, Xiangming Fang

Abstract

Background: Patients undergoing upper gastrointestinal endoscopic surgeries are generally placed in the left lateral position and require endotracheal intubation to maintain airway patency. We conducted a prospective, randomized, controlled study to evaluate the feasibility of intubation under video laryngoscopic guidance in the left lateral position during upper gastrointestinal endoscopic surgery.

Methods: We compared the data of patients (n = 120) who underwent intubation under video laryngoscopic guidance in the supine or left lateral position. Patients in Group S (n = 59) were initially placed in the supine position and then shifted to the left lateral position after airway establishment. Patients in Group L (n = 61) were placed in the left decubitus position during both induction and intubation. Laryngoscopic view, intubation time, success rate, hemodynamic changes, adverse effects, and complications of intubation were compared between the groups.

Results: The 2 groups showed no difference in terms of time required for intubation (Group L, 23.95 ± 4.43 seconds and Group S, 23.44 ± 4.78 seconds; P = .545) and number of intubation attempts. Further, the overall rate of intubation success was 100% in both groups. However, Group S exhibited significant hemodynamic changes during shift of decubitus (P < .001) and severe sore throat (P = .030). The incidences of other adverse effects such as productive cough, dryness of mouth, hoarseness, oral mucosal injury, dental injury, and hypoxia in the 2 groups were comparable.

Conclusion: We concluded that intubation in the lateral position under video laryngoscopic guidance is safe and feasible performed in the left lateral position and prevents the hemodynamic change and sore throat resulting from change in decubitus.

Conflict of interest statement

The authors declare no conflicts of interest for this article.

Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.

Figures

Figure 1
Figure 1
Procedure of the study and measurements applied. Group L: Endotracheal intubation with patients in the left lateral position; Group S: Endotracheal intubation with patients in the supine position.
Figure 2
Figure 2
Endotracheal intubation with patients in the supine and left lateral position. A. The supporting pillow for Group S; B. The supporting pillow for Group L; C. Endotracheal intubation with patients in the supine position; D. Endotracheal intubation with patients in the left lateral position, Group L: Endotracheal intubation with patients in the left lateral position; Group S: Endotracheal intubation with patients in the supine position.
Figure 3
Figure 3
Flow diagram showing the study enrolment procedure. Group L: Endotracheal intubation with patients in the left lateral position; Group S: Endotracheal intubation with patients in the supine position. ASA = American Society of Anesthesiologists; COPD= chronic obstructive pulmonary disease.
Figure 4
Figure 4
Mean arterial blood pressure (MAP) and heart rate (HR) measurements during the peri-intubation period. In both groups, the MAP values at T1 (P < .001), T2 (P < .001), T3 (P < 0.001), T4 (P < .001), and T5 (P < .001) differed significantly from the values before anesthesia (BA). Similarly, the HR values at T1 (P < .001), T2 (P < .001), T3 (P < .001), T4 (P < .001), and T5 (P < .001) differed significantly from those BA in both Group L and Group S., Group L: Endotracheal intubation with patients in the left lateral position; Group S: Endotracheal intubation with patients in the supine position. BA: before anesthesia induction; T1: after induction of anesthesia but before tracheal intubation; T2: immediately after successful intubation; T3: 3 min after tracheal intubation and before the patients in Group S were turned to the left lateral decubitus; T4: 5 min after tracheal intubation/after the patients in Group S were turned to the left lateral position; and T5: 10 min after tracheal intubation.

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