Evaluation of mask ventilation, laryngoscopy and endotracheal intubation in the lateral position

Background: The need to perform endotracheal intubation in lateral position may be occasionally encountered by the anaesthesiologist. We compared the ease of mask ventilation and intubation in supine and lateral positions. Patients & Methods: 72 patients were randomly allocated into one of two groups: Group RL (Right lateral) and Group LL (Left lateral). After induction of anaesthesia and establishment of neuromuscular blockade, ease of mask ventilation and laryngoscopy were assessed in supine position and then in lateral position (right or left as per the group assigned). The effect of BURP manoeuvre was also noted. Intubation time and success rate were compared between the two lateral positions. Results: Mask ventilation was easy in all 72 patients in supine position but was difficult in 6 patients in the lateral position. Time to laryngoscopy was shorter in supine position than lateral position but did not reach clinical significance. Laryngoscopic grade was worse in lateral than in supine position (41.66% of patients had a deterioration of laryngoscopic grade). BURP manoeuvre improved laryngoscopic grades in both supine and lateral position. The ease of mask ventilation, and intubation were not different in right or left lateral positions. Endotracheal intubation was successful in all patients in lateral position although a total of seven patients required a second attempt. Conclusions: Mask ventilation and laryngoscopy are more difficult in lateral position than in supine position. There is no difference in ease of mask ventilation, laryngoscopy or intubation between right and left lateral positions. BURP manoeuvre is an useful aid for laryngoscopy.