A simple blind placement of the left-sided double-lumen tubes

Abstract

One-lung ventilation (OLV) has been commonly provided by using a double-lumen tube (DLT). Previous reports have indicated the high incidence of inappropriate DLT positioning in conventional maneuvers.After obtaining approval from the medical ethics committee of First Affiliated Hospital of Anhui Medical University and written consent from patients, 88 adult patients belonging to American society of anesthesiologists (ASA) physical status grade I or II, and undergoing elective thoracic surgery requiring a left-side DLT for OLV were enrolled in this prospective, single-blind, randomized controlled study. Patients were randomly allocated to 1 of 2 groups: simple maneuver group or conventional maneuver group. The simple maneuver is a method that relies on partially inflating the bronchial balloon and recreating the effect of a carinal hook on the DLTs to give an idea of orientation and depth. After the induction of anesthesia the patients were intubated with a left-sided Robertshaw DLT using one of the 2 intubation techniques. After intubation of each DLT, an anesthesiologist used flexible bronchoscopy to evaluate the patient while the patient lay in a supine position. The number of optimal position and the time required to place DLT in correct position were recorded.Time for the intubation of DLT took 100 ± 16.2 seconds (mean ± SD) in simple maneuver group and 95.1 ± 20.8 seconds in conventional maneuver group. The difference was not statistically significant (P = 0.221). Time for fiberoptic bronchoscope (FOB) took 22 ± 4.8 seconds in simple maneuver group and was statistically faster than that in conventional maneuver group (43.6 ± 23.7 seconds, P < 0.001). Nearly 98% of the 44 intubations in simple maneuver group were considered as in optimal position while only 52% of the 44 intubations in conventional maneuver group were in optimal position, and the difference was statistically significant (P < 0.001).This simple maneuver is more rapid and more accurate to position left-sided DLTs, it may be substituted for FOB during positioning of a left-sided DLT in condition that FOB is unavailable or inapplicable.

Virtues of Using a Double Lumen Tube for Anesthesia in Patients with Endobronchial Tumours Requiring Open Lung Resection or Bronchoplastic Procedures

“…The use of DLT for OLV while performing a thoracotomy has not been well studied and is always thought of as an additional benefit to give the surgeon a static field, improve visualization and prevent con- In right side endobronchial tumours, the decision to insert a left sided DLT should be more straightforward. Firstly, right side endobronchial carcinoids (which is the most common endobronchial tumour) are much more common on the right side and secondly, that left side DLT can be performed blindly even with the unavailability of a fiberoptic bronchoscopy [4]. The margin of success in correct placement is higher for placing a left-sided DLT due to the longer length of the corresponding left main stem bronchus.…”

Confirmation of endotracheal tube placement using disposable fiberoptic bronchoscopy in the emergent setting

“…A similar approach of threading the bronchoscope through the tube is also considered the gold standard in confirmation of double lumen endotracheal tubes used by thoracic surgeons in single lung ventilation. [23,24] Adjunct approaches such as listening for bilateral breath sounds are useful but challenging in the loud, chaotic initial stages of patient arrival, and are made much more difficult by active compressions. Likewise, chest X-ray, pulse oximetry, fogging of the ET tube and visualization of chest rise provide useful data, but are "not sufficiently reliable to confirm endotracheal tube placement", according to current policy standards.…”

A simple blind placement of the left-sided double-lumen tubes

“…In the article “A simple blind placement of the left-sided double-lumen tubes”, [ 1 ] which appeared in Volume 95, Issue 45 of Medicine , the Methods section incorrectly stated the numbers of men and women who participated in the study. The statement should have read as follows:…”