A novel endoscopy-guided airway management strategy for lateral decubitus endoscopic procedures

This study investigates the feasibility and safety of gastrointestinal endoscopy-guided endotracheal intubation in patients undergoing elective gastrointestinal endoscopic surgery under general anesthesia requiring airway management in the lateral decubitus position.

Forty patients undergoing elective gastrointestinal endoscopy in the left lateral decubitus position were enrolled. Standardized anesthesia induction included midazolam, etomidate, sufentanil, and atracurium. Under endoscopic visualization, endotracheal intubation was performed using a stiff stylet-assisted tube inserted through a bite block's right lateral port. Primary outcomes were first-attempt success rate and intubation time. Secondary outcomes included hemodynamic stability, adverse events, and procedural complications.

The first-attempt intubation success rate was 100%. The mean intubation time was 30.95 ± 6.58 s. Hemodynamic parameters showed a transient hypotensive response following induction in 15 out of 40 patients (37.5%); MAP had returned to ≥65 mmHg by the post-intubation measurement, and no vasopressor agents were administered. Repeated-measures ANOVA revealed a statistically significant main effect of time on both MAP [F (3.048, 118.888) = 23.05, p < 0.001, partial η ² = 0.372] and HR [F (4, 156) = 3.258, p = 0.013, partial η ² = 0.077], with a transient stress response observed post-intubation (maximal increase: MAP +4.5%, HR +6.1% vs. baseline). No severe complications (e.g., esophageal intubation, dental injury, hypoxia) occurred (0/40; 95% CI: 0%-8.8%). Mild sore throat was observed in 22.5% of cases, resolving spontaneously within 24 h.

In this feasibility cohort, gastrointestinal endoscopy-guided endotracheal intubation demonstrated a 100% first-attempt success rate with a mean intubation time of 30.95 ± 6.58 s and no severe complications. These preliminary findings suggest that the technique appears to be a feasible and safe option for airway management in patients undergoing lateral-position gastrointestinal endoscopy. However, these findings are from an uncontrolled, single-center study with a limited sample size. Larger comparative studies are warranted to confirm these results.

https://clinicaltrials.gov/, identifier NCT06990490.