Pre-shaping double-lumen endotracheal tubes based on video laryngoscope blade curvature enhances first-attempt intubation success rate in patients undergoing thoracoscopic surgery: a randomized controlled trial.

BACKGROUND

The widespread adoption of video laryngoscopes (VLs) in double-lumen endotracheal tube (DLT) intubation has not resolved controversies regarding their efficacy in improving first-attempt success rates. This study aimed to evaluate the safety and efficacy of pre-shaping DLTs according to the VL blade curvature for tracheal intubation in patients undergoing thoracoscopic surgery.

METHODS

A total of 90 patients scheduled for elective thoracoscopic surgery under general anesthesia with left-sided DLT intubation were enrolled. The patients were aged ≥18 years and had an American Society of Anesthesiologists (ASA) physical status I or II. All patients were divided into two groups using a random number table method: a video laryngoscope blade curvature-based pre-shaping group (Group P, n = 45) and a traditional empirical shaping group (Group T, n = 45). All patients underwent total intravenous anesthesia and were intubated under VL. The primary outcome was the first-attempt intubation success rate. Secondary outcomes included tube malposition rate, time for DLT passage through the glottis, total intubation time, mean arterial pressure (MAP), and heart rate (HR) at baseline (pre-induction), post-induction, during intubation, and 5 min post-intubation. Complications related to intubation within 48 h after surgery, such as pharyngolaryngeal pain, hoarseness, and lip and dental injuries, were also documented.

RESULTS

Compared to Group T, Group P demonstrated a significantly higher first-attempt intubation success rate (91.1% vs. 72.7%, p < 0.01), shorter time for tube passage through the glottis (14.2 ± 3.1 vs. 29.5 ± 4.8 s, p < 0.01), and reduced total intubation time (58.3 ± 10.2 vs. 82.6 ± 12.4 s, p < 0.01). During intubation, Group P exhibited significantly lower MAP and HR compared to Group T (p < 0.05). Furthermore, the incidence of postoperative pharyngolaryngeal pain (13.3% vs. 31.8%, p < 0.01) and lip injuries (6.7% vs. 18.2%, p < 0.01) within 48 h was markedly lower in Group P.

CONCLUSION

Pre-shaping DLTs based on VL blade curvature improves the first-attempt intubation success rate while minimizing intubation-related trauma in thoracoscopic surgery.

CLINICAL TRIAL REGISTRATION: https://www.chictr.org.cn/bin/home, identifier ChiCTR2400080906.