Efficacy and Risk Assessment of Lateral Position Endotracheal Intubation Combined with Airway Surface Anesthesia in Gastrointestinal Endoscopic Surgery: A Randomized Controlled Non-Inferiority Study.

Purpose: This study aims to evaluate and compare the efficacy and safety of endotracheal intubation in the lateral versus supine position, with both approaches combined with airway surface anesthesia, in patients undergoing gastrointestinal endoscopic surgery.

Patients and methods: A total of 128 patients undergoing gastrointestinal endoscopic surgery under general anesthesia with intubation were randomized into a lateral (L, n=64) or supine (S, n=64) intubation group, both receiving airway surface anesthesia, between January and March 2025. The primary outcome measure was intubation time, while secondary outcomes included changes in intraoperative vital signs, number of intubation attempts, first-pass success rate, positioning time, healthcare worker satisfaction, and postoperative complications.

Results: No significant differences were found between the two groups in terms of age, sex, height, weight, BMI, ASA classification, and airway assessment (P > 0.05). Mean intubation times differed slightly between groups (S group: 37.4±7.6s, 95% CI 35.5-39.3; L group: 40.1±8.5s, 95% CI 38.0-42.2). The non-inferiority margin (δ) for this study was 6s, and the upper limit of the L group's confidence interval (42.2s) was below the threshold of 39.3 + 6s. Thus, lateral position intubation was not inferior to supine intubation in terms of intubation time. There were no significant differences between the groups in the number of intubation attempts or first-pass success rate (P > 0.05). However, during positioning, the S group experienced greater hemodynamic fluctuations and a longer positioning time compared to the L group, and these differences were statistically significant (P < 0.05). Neither group showed any dental injuries or hypoxemia, and there were no significant differences in adverse reactions between the groups (P > 0.05).

Conclusion: Compared with conventional supine intubation, lateral position endotracheal intubation with airway surface anesthesia achieves similar efficacy while providing better hemodynamic stability, faster positioning, and higher provider satisfaction.