Application of Tracheal Intubation in Lateral Position in Thoracic Surgery

NCT ID: NCT05482230

Last Updated: 2025-05-16

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

306 participants

Study Classification

INTERVENTIONAL

Study Start Date

2022-12-12

Study Completion Date

2024-05-30

Brief Summary

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

Detailed Description

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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.

Conditions

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Anesthesia Tracheal Intubation Thoracic Surgery

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Intubation and bronchial blocker placement performed in lateral position.
Primary Study Purpose

SUPPORTIVE_CARE

Blinding Strategy

SINGLE

Outcome Assessors

Study Groups

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Intubation 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.

Group Type EXPERIMENTAL

Intubation and bronchial blocker placement performed in lateral position

Intervention Type PROCEDURE

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.

Intubation and bronchial blocker placement performed in supine position

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.

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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Intubation 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.

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

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

Exclusion Criteria

* 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.
Minimum Eligible Age

18 Years

Maximum Eligible Age

80 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Red Cross Hospital, Hangzhou, China

OTHER

Sponsor Role collaborator

The Central Hospital of Lishui City

OTHER

Sponsor Role collaborator

Affiliated Hospital of Guangdong Medical University

OTHER

Sponsor Role collaborator

Affiliated Hospital of Jiaxing University

OTHER

Sponsor Role collaborator

Affiliated Hospital of Shaoxing University

UNKNOWN

Sponsor Role collaborator

Lishui Country People's Hospital

OTHER

Sponsor Role collaborator

xiangming fang

OTHER

Sponsor Role lead

Responsible Party

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xiangming fang

Chair Professor, Department of Anesthesiology Vice Dean, School of Medicine and and Pharmaceutical sciences Zhejiang University

Responsibility Role SPONSOR_INVESTIGATOR

Principal Investigators

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Xiangming Fang, Professor

Role: PRINCIPAL_INVESTIGATOR

First Affilated Hospital of Zhejiang University

Locations

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Jie Zhao

Hangzhou, Zhejiang, China

Site Status

Countries

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China

References

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Almeida C, Freitas MJ, Brandao D, Assuncao JP. [Use of bronchial blocker in emergent thoracotomy in presence of upper airway hemorrhage, and cervical spine fracture: a difficult decision]. Braz J Anesthesiol. 2018 Jul-Aug;68(4):408-411. doi: 10.1016/j.bjan.2017.09.004. Epub 2018 Jan 17.

Reference Type BACKGROUND
PMID: 29342420 (View on PubMed)

Lewis JW Jr, Serwin JP, Gabriel FS, Bastanfar M, Jacobsen G. The utility of a double-lumen tube for one-lung ventilation in a variety of noncardiac thoracic surgical procedures. J Cardiothorac Vasc Anesth. 1992 Dec;6(6):705-10. doi: 10.1016/1053-0770(92)90056-d.

Reference Type BACKGROUND
PMID: 1472668 (View on PubMed)

Komatsu R, Nagata O, Sessler DI, Ozaki M. The intubating laryngeal mask airway facilitates tracheal intubation in the lateral position. Anesth Analg. 2004 Mar;98(3):858-61, table of contents. doi: 10.1213/01.ane.0000100741.46539.6b.

Reference Type BACKGROUND
PMID: 14980953 (View on PubMed)

Goh SY, Thong SY, Chen Y, Kong AS. Efficacy of intubation performed by trainees on patients in the lateral position. Singapore Med J. 2016 Sep;57(9):503-6. doi: 10.11622/smedj.2015165. Epub 2015 Nov 13.

Reference Type BACKGROUND
PMID: 26768062 (View on PubMed)

Dimitriou V, Voyagis GS, Iatrou C, Brimacombe J. Flexible lightwand-guided intubation using the intubating laryngeal mask airway in the supine, right, and left lateral positions in healthy patients by experienced users. Anesth Analg. 2003 Mar;96(3):896-898. doi: 10.1213/01.ANE.0000048839.12552.50.

Reference Type BACKGROUND
PMID: 12598281 (View on PubMed)

Biswas BK, Agarwal B, Bhattacharyya P, Badhani UK, Bhattarai B. Intubating laryngeal mask for airway management in lateral decubitus state: comparative study of right and left lateral positions. Br J Anaesth. 2005 Nov;95(5):715-8. doi: 10.1093/bja/aei226. Epub 2005 Sep 2.

Reference Type BACKGROUND
PMID: 16143578 (View on PubMed)

Takenaka I, Aoyama K, Iwagaki T, Kadoya T. Efficacy of the Airway Scope on tracheal intubation in the lateral position: comparison with the Macintosh laryngoscope. Eur J Anaesthesiol. 2011 Mar;28(3):164-8. doi: 10.1097/EJA.0b013e328340c368.

Reference Type BACKGROUND
PMID: 20962657 (View on PubMed)

Jin Y, Ying J, Zhang K, Fang X. Endotracheal intubation under video laryngoscopic guidance during upper gastrointestinal endoscopic surgery in the left lateral position: A randomized controlled trial. Medicine (Baltimore). 2017 Dec;96(52):e9461. doi: 10.1097/MD.0000000000009461.

Reference Type BACKGROUND
PMID: 29384933 (View on PubMed)

Li H, Wang W, Lu YP, Wang Y, Chen LH, Lei LP, Fang XM. Evaluation of Endotracheal Intubation with a Flexible Fiberoptic Bronchoscope in Lateral Patient Positioning: A Prospective Randomized Controlled Trial. Chin Med J (Engl). 2016 Sep 5;129(17):2045-9. doi: 10.4103/0366-6999.189069.

Reference Type BACKGROUND
PMID: 27569229 (View on PubMed)

Lai HC, Wu ZF. Easier double-lumen tube placement using real-time video laryngoscopy and wireless video fiberoptic bronchoscopy. J Clin Anesth. 2019 Aug;55:132-133. doi: 10.1016/j.jclinane.2018.12.023. Epub 2019 Jan 15. No abstract available.

Reference Type BACKGROUND
PMID: 30658325 (View on PubMed)

Birring SS, Brew J, Kilbourn A, Edwards V, Wilson R, Morice AH. Rococo study: a real-world evaluation of an over-the-counter medicine in acute cough (a multicentre, randomised, controlled study). BMJ Open. 2017 Jan 16;7(1):e014112. doi: 10.1136/bmjopen-2016-014112.

Reference Type BACKGROUND
PMID: 28093442 (View on PubMed)

Saini S, Bhanot A, Kamal K, Bansal T. An improvised head support to facilitate endotracheal intubation in the lateral position. Acta Anaesthesiol Taiwan. 2015 Sep;53(3):109-11. doi: 10.1016/j.aat.2015.04.001. Epub 2015 Apr 24. No abstract available.

Reference Type BACKGROUND
PMID: 25987271 (View on PubMed)

Li H, Chu L, Ye H, Zhang Y, Li M, Hua Y, Zhang J, Hu H, Wen T, Zhao J, Wan H, Huang L, Lou Y, Tang J, Yan Z, Duan G, Wu J, Wang C, Lu Y, Shen X, Huang C, Song C, Wang Y, Zeng C, Xie G, Fang X. Lung isolation with a bronchial blocker placed in the lateral position for patients undergoing thoracic surgery: A multicenter, randomized clinical trial. J Clin Anesth. 2025 Jun;104:111869. doi: 10.1016/j.jclinane.2025.111869. Epub 2025 May 13.

Reference Type DERIVED
PMID: 40367865 (View on PubMed)

Other Identifiers

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2015299

Identifier Type: -

Identifier Source: org_study_id

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