Ababneh Omar, Bsisu Isam, El-Share' Ahmad I, Alrabayah Mustafa, Qudaisat Ibraheem, Alghanem Subhi, Khreesha Lubna, Ali Amani Mohamed, Rashdan Mohammad
Department of Anesthesia and Intensive Care, School of Medicine, The University of Jordan, Amman 11942, Jordan.
UCSF Center for Health Equity in Surgery and Anesthesia, San Francisco, CA 94158, USA.
Healthcare (Basel). 2023 Oct 24;11(21):2818. doi: 10.3390/healthcare11212818.
Obesity is a well-recognized risk factor for difficult intubation. To safely manage and overcome airway challenges in severely obese patients with a suspected difficult airway, awake fiberoptic intubation is recommended. We aimed to investigate the utility of awake nasal fiberoptic intubation in severely obese patients with suspected difficult airway while positioning them in the lateral decubitus position.
This randomized controlled trial compared lateral and supine positions for awake nasal fiberoptic intubation in severely obese patients with an anticipated difficult airway by assessing the success rate, time needed to secure the airway, peri-procedural adverse events, and postoperative satisfaction of patients.
Sixty patients with a median age of 37 [inter-quartile range (IQR): 29-44] years were included, of which 47 (78.3%) were females. The median body mass index (BMI) was 45.5 [IQR: 42.5-50.8] kg/m. The success rate of fiberoptic intubation was 100% in both groups. The time needed to successfully secure the airway was 188 [148.8-228.8] seconds (s) in the lateral position, compared to 214.5 [181.8-280.5] s in supine position ( = 0.019). Intraprocedural cough was more common in the supine position group ( = 8; 26.7%), compared to the lateral position group ( = 3; 10%; = 0.095). Postoperative sore throat was more common in the lateral position group ( = 12; 40%) compared to the supine position ( = 5; 16.7%; = 0.045).
In conclusion, Intubation in the lateral position is a promising technique that is equivalent to the routine supine position during fiberoptic intubation. In fact, intubation in the lateral position took less time to successfully secure the airway.
肥胖是公认的困难插管风险因素。为安全处理和克服疑似困难气道的严重肥胖患者的气道挑战，建议采用清醒纤维支气管镜插管。我们旨在研究在将严重肥胖且疑似困难气道的患者置于侧卧位时，清醒经鼻纤维支气管镜插管的效用。
这项随机对照试验通过评估成功率、确保气道安全所需时间、围手术期不良事件以及患者术后满意度，比较了严重肥胖且预期气道困难的患者在清醒经鼻纤维支气管镜插管时的侧卧位和仰卧位。
纳入了60例患者，中位年龄为37岁[四分位间距（IQR）：29 - 44岁]，其中47例（78.3%）为女性。中位体重指数（BMI）为45.5[IQR：42.5 - 50.8]kg/m²。两组纤维支气管镜插管成功率均为100%。侧卧位成功确保气道安全所需时间为188[148.8 - 228.8]秒（s），仰卧位为214.5[181.8 - 280.5]秒（P = 0.019）。术中咳嗽在仰卧位组更常见（n = 8；26.7%），而侧卧位组为（n = 3；10%；P = 0.095）。术后咽痛在侧卧位组更常见（n = 12；40%），而仰卧位组为（n = 5；16.7%；P = 0.045）。
总之，侧卧位插管是一种有前景的技术，在纤维支气管镜插管过程中与常规仰卧位相当。事实上，侧卧位插管成功确保气道安全所需时间更短。
