Anesthesia, Thoracic Surgery, Tracheal Intubation
Conditions
Keywords
Lateral Position, Bronchial occluder
Brief summary
This study investigated the incidence of bronchial blocker malposition in the lateral versus supine position and evaluated the effectiveness of lateral placement.
Detailed 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.
Interventions
PROCEDUREIntubation and bronchial blocker placement performed in lateral position
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.
Sponsors
Red Cross Hospital, Hangzhou, China
The Central Hospital of Lishui City
Affiliated Hospital of Guangdong Medical University
Affiliated Hospital of Jiaxing University
Affiliated Hospital of Shaoxing University
Lishui Country People's Hospital
xiangming fang
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
SINGLE (Outcomes Assessor)
Intervention model description
Intubation and bronchial blocker placement performed in lateral position.
Eligibility
Sex/Gender
ALL
Age
18 Years to 80 Years
Healthy volunteers
No
Inclusion 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.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| The incidence of bronchial blocker malposition. | During surgery | The incidence of bronchial blocker malposition in two groups S and L |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| The duration of intubation | During surgery | The duration of intubation, including the time for single-lumen tube intubation, the time for bronchial blocker placement, and the total intubation time (single-lumen tube intubation plus bronchial blocker placement) |
| The pressure of ventilation | During surgery | The pressure of ventilation during mask ventilation, two-lung ventilation (TLV) and one-lung ventilation(OLV) |
| Intubation-related complications | During surgery, after the patient regained full consciousness and before discharge from the post-anesthesia care unit, on the day after surgery, and 2 weeks postoperatively. | Intubation-related complications, including airway injury, dental injury, sore throat, and hoarseness |
| Postural injuries | These complications were assessed at three time points: after the patient regained full consciousness and before discharge from the post-anesthesia care unit, on the day after surgery, and 2 weeks postoperatively. | Postural injuries were defined as new-onset injuries not present before surgery but occurring within the first 2 weeks postoperatively, including neuropathies, vasculopathies, and musculoskeletal injuries |
| The times of bronchial blocker reposition | During surgery | The times of bronchial blocker reposition in lateral group and supine group |
| Perioperative vital signs | Immediately after arrival at operating room; Before single lumen tube intubation; After single lumen tube intubation ; One-lung ventilation; Before single lumen tube extubating; 5 minutes after single lumen tube extubating. | Perioperative vital signs, including mean arterial pressure (MAP), heart rate (HR), and SpO2 |
| Hypoxemia | During surgery | Hypoxemia was defined as a drop in oxygen saturation (SpO2) below 92% |
| The satisfaction scores | Perioperative period | The satisfaction scores of patients, nurses and surgeons. Satisfaction scores were used a 0-10 scale (10 = very satisfied). |
| Lung collapse grade | During surgery | When the chest wall was opened, the lung collapse was graded as follows: fully collapsed lung, non-collapsed lung with no visible ventilation, or fully ventilated lung |
Countries
China
Outcome results
None listed