Video-assisted Fiberoptic Intubation in Lateral Versus Supine Position in Children Undergoing Non-head-and-neck Surgery: A Randomized Controlled Trial

What this Trial Is About

Fiberoptic intubation, first described in the late 1960s, is a well-established method for managing airways in awake, sedated, and anesthetized patients. It is especially useful for individuals with known or suspected difficult airways such as limited mouth opening, reduced neck mobility, cervical spine injury, obesity, or higher risk of aspiration. This technique offers fewer complications like tooth injury or bleeding and helps position double-lumen tubes optimally during thoracic surgeries. However, intubation in the lateral position during surgery presents challenges with direct laryngoscopy, making fiberoptic intubation a potentially valuable alternative, particularly in emergency or special surgical situations. Currently, there is a lack of studies comparing fiberoptic intubation between lateral and supine positions in pediatric patients. This trial evaluates the use of video-assisted fiberoptic intubation performed in either the lateral or supine position in children aged 2 to 10 years undergoing elective non-head-and-neck surgeries. In both groups, an assistant holds the tongue forward, and a bronchoscope is advanced orally to the laryngeal inlet, with the glottic view graded from 1 to 5. The scope is guided through the vocal cords to the carina to place the endotracheal tube, followed by confirmation using chest auscultation and capnography. If oxygen saturation drops to 90% during intubation, the procedure pauses for ventilation until saturation returns to 100%. Participants will be monitored from the start of intubation, with the primary outcome measuring the time taken to intubate within 5 minutes of scope insertion. The study includes children with ASA physical status I and II undergoing elective surgeries, excluding those with head or neck surgeries, congenital deformities, neuromuscular disorders, or emergency cases. Safety monitoring includes oxygen saturation levels, and the study aims to determine whether fiberoptic intubation in the lateral position is as effective and safe as in the supine position in pediatric patients.

Fiberoptic Intubation in Lateral Versus Supine Position in Pediatrics Undergoing Non-head-and-neck Surgery