Airway management and hemodynamic response to laryngoscopy and intubation in supine and left lateral positions

Intubation in the lateral position is desirable in several conditions. We compared the technical ease and hemodynamic response to laryngoscopy and intubation in the lateral (group L) and supine (group S) positions in 120 patients with normal airway in a prospective randomized controlled study.

This was a randomized, controlled observational study. All intubations were performed by a single investigator experienced in lateral intubation. Ventilation score with bag and mask ventilation, laryngoscopy duration and attempts, application of external pressure and Cormac & Lehane grade were measured. Blood pressure and heart rate were observed before and after induction of anesthesia, after laryngoscopy/intubation and then at one minute interval for 6 minutes.

90% of patients in group S were ventilated by a single operator compared to 17% in group L. Duration oflaryngoscopy was significantly longer in group L (32 seconds) compared to group S (12 seconds) [p < 0.001]. 78% of the patients in group S had Cormack and Lehane grade 1 versus nil in group L. External pressure was required in 58% patients in group L and 5% in group S. In intra-group comparison at specified time lines no difference was observed in HR but the changes in BP were significantly higher in the lateral position (P-value < 0.001).

Ventilation and intubation in lateral position was more difficult technically than in the suprine position, and the BP response was exaggerated in the lateral position.