Background: Accurate knowledge of the mainstem bronchial lengths is essential in order to prevent malpositioning of the double lumen endobronchial tubes (DLT). It is believed that the lengths of the left and right mainstem bronchi measured by CT are more accurate than those measured using a fiberoptic bronchoscope. This study evaluated the length of the mainstem bronchus using a CT scan in Korean adults.Methods: One hundred twenty patients who underwent a chest CT scan without any anatomical changes due to a mass or inflammation were examined. Airway imaging with a minimum intensity projection of the oblique coronal section using multidetector CT was obtained and the lengths of the left and right mainstem bronchi were measured.Results: The lengths of the left mainstem bronchus of the males and females were 49.2 ± 4.8 mm and 44.6 ± 3.9 mm respectively, and the right mainstem bronchus of the males and females were 21.0 ± 4.8 mm and 18.0 ± 4.0 mm, respectively. There was no linear correlation between the height of the patients and the length of the left and right mainstem bronchi.Conclusions: These results provide reference data to help determine the precise margin of safety using a double lumen endobronchial tube for thoracic surgery.
Background: Double-lumen endobronchial tube (DLT) malposition and displacement can occur easily by blind intubation or moving a patient into the lateral position. We compared a silicon DLT (Silbroncho Ⓡ ) with a polyvinyl chloride tube (Broncho-Cath Ⓡ ) to determine whether Silbroncho Ⓡ can reduce the incidence of DLT malposition and displacement during anesthesia for one lung ventilation in right-side thoracic surgery. Methods: Thirty nine patients requiring right lung deflation were randomly assigned to one of two groups. Eighteen patients received a Broncho-Cath Ⓡ DLT and 21 patients received a Silbroncho Ⓡ in the left mainstem bronchus. After blind intubation, we checked the incidence of right DLT intubation and tracheobronchial injury by fiberoptic bronchoscopy (FOB). After correcting DLTs for exact position and moving patients into the lateral position, we assessed the incidence of DLT displacement and changes of peak inspiratory pressure according to this position change during one lung ventilation. Results: The incidence of right DLT intubation and tracheobronchial injury were not significantly different (P > 0.05) in the two groups (16.7% vs 0%, 38.9% vs 14.3%, Broncho-Cath Ⓡ vs Silbroncho Ⓡ , respectively). After position change, the incidence of DLT displacement in the Silbroncho Ⓡ group (4.8%) was lower (P < 0.05) than in the Broncho-Cath Ⓡ group (44.8%). No significant difference was found between the two groups in terms of peak inspiratory pressure (P > 0.05).Conclusions: Our results suggest that Silbroncho Ⓡ can reduce the incidence of DLT displacement because of the small-sized bronchial cuff, which is located more distally than the Broncho-Cath Ⓡ cuff. We conclude that Silbroncho Ⓡ is superior to Broncho-Cath Ⓡ for one lung ventilation during thoracic surgery.
Prolotherapy is a non-surgical injection treatment method that repeatedly injects small amounts of proliferators into damaged ligaments, tendon, joints and surrounding tissues. The most common proliferator is a high concentration of glucose solution. Glucose solutions with a concentration of 10-25% are commonly used. Prolotherapy using glucose solution has few serious adverse events, but common side effects include post injection pain, stiffness, edema, and mild bleeding. There are many cases of complaining of pain caused by injection during or after prolotherapy. Some patients give up treatment if the pain is severe. A 43-year-old male patient visited the hospital with both elbow pain and left wrist pain, and prolotherapy was performed. In order to minimize pain during procedure and post injection pain of the patient, 10% glucose solution with 0.5% lidocaine was injected using a very fine needle of 30 G. The total number of treatments was eight. The patient did not complain of pain caused by needle insertion during procedure and post-injection pain. Chronic pain that lasted for two years after treatment almost disappeared. The patient was very satisfied with this treatment method and result.
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