Application of Tracheal Intubation in Lateral Position in Thoracic Surgery

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.

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.