Endotracheal intubation of patients in left semi-prone position before endoscopic retrograde cholangiopancreatography: A randomised controlled study

• Published in: Indian journal of anaesthesia Vol. 66; no. 10; pp. 700 - 706
• Main Authors: Apinyachon, Worapot, Thamnoranart, Methinee, Lavanrattanakul, Phisut, Sangasilpa, Inthuon, Suragul, Wikran
• Format: Journal Article
• Language: English
• Published: India Medknow Publications & Media Pvt Ltd 01.10.2022; Medknow Publications and Media Pvt. Ltd; Medknow Publications & Media Pvt. Ltd; Wolters Kluwer - Medknow
• Edition: 2
• Subjects: Endoscopic retrograde cholangiopancreatography; Endoscopy; Intubation; Methods; Original; Original Article; Patients; Success; Trachea; India; endoscopic retrograde cholangiopancreatography; patient positioning; laryngoscopy; intubation; Airway management
• ISSN: 0019-5049; 0976-2817
• DOI: 10.4103/ija.ija_165_22

ABSTRACT Background and Aims: Endoscopic retrograde cholangiopancreatography (ERCP) is generally performed with the patient in the left semi-prone position. The patients are usually intubated in the supine position and subsequently turned to the left semi-prone position. This turning procedure may cause the injuries to the patient or unstable haemodynamics. Previous studies show that the success rates of intubation in the lateral position are comparable to that of intubation in the supine position, even so, there are some difficulties. Therefore, this study is aimed to investigate the effect of the semi-prone position on the success rate of intubation. Methods: This randomised controlled trial included 88 patients aged 18 to 80 years with an American Society of Anesthesiologists physical status (ASA PS) of I-III with no predicted difficult intubation, and who were undergoing ERCP. The subjects were randomly assigned to be intubated in the supine or semi-prone position. The 44 patients in the supine group were intubated in the supine position. The other 44 patients were intubated in the semi-prone position. The primary outcome was the success rate of the first intubation attempt. Results: There were no differences between the two groups in age, ASA PS and preoperative airway characteristics. Endotracheal intubation was successful in all patients with the first intubation attempt successful in 43 patients (97.7%) in the supine group and 42 (95.5%) in the semi-prone group (P = 0.556). Conclusion: For patients undergoing ERCP, the success rate of endotracheal intubation in the left semi-prone position was comparable to that in the supine position.