Comparison of techniques for double-lumen endobronchial intubation: 90° or 180° rotation during advancement through the glottis

Abstract

Rotation of a DLT through 180° facilitated its passage through the glottis and reduced the incidence of postoperative sore throat and vocal cord injuries.

The effects of thermal softening of double-lumen endobronchial tubes on postoperative sore throat, hoarseness and vocal cord injuries: a prospective double-blind randomized trial

“…A number of methods for reducing postoperative sore throat have been used for the single-lumen tracheal tubes, 10 16-25 whereas only a few studies have been conducted for DLTs, 7 13 15 despite the fact that intubation of DLTs is more traumatic to the airway. Compared with the known methods for attenuating postoperative sore throat, such as premedication with dexamethasone, 13 180°rotation technique of DLTs, 7 and use of silicone DLTs, 15 thermal softening is a simple technique that carries no pharmacological side-effects and can be performed at the bedside.…”

“…9 If severe resistance was encountered at the glottis, the DLT was further rotated counterclockwise up to 180°directing the tracheal lumen anteriorly and its advancement through the glottis was attempted. 7 After removing the headrest, 8 the patient's head was placed in the neutral position, and the DLT position was correctly adjusted under fibreoptic bronchoscopy. If the DLT was misdirected into the right bronchus, it was repositioned into the left bronchus under fibreoptic bronchoscopic guidance.…”

“…The epidural regimen for thoracotomy consisted of 0.12% levobupivacaine and fentanyl at 2 mcg ml −1 , with a total volume of 500 ml at a continuous infusion rate of 6 ml h −1 and 0.5-ml bolus with a lockout interval of 20 min. 7 The patient-controlled analgesia was continued until the third postoperative day.…”

A Comparison of the Efficacy and Adverse Effects of Double-Lumen Endobronchial Tubes and Bronchial Blockers in Thoracic Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Trials

“…35 Conventionally, the DLT will be rotated 90 degrees after passing the vocal cords. However, it has been shown that rotating it by 180 degrees causes fewer airway injuries, 36 so placement technique could reduce the incidence of injuries associated with placement of DLTs.…”

The Effects of Anesthesiologist Experience on Postoperative Hoarseness After Double-Lumen Endotracheal Tube Intubation: A Single-Center Propensity Score-Matched Analysis

“…One possible explanation for this difference may be that DLT intubation requires more technical skills than SLT intubation for the following reasons. First, a DLT has a solid curved body, which can easily come into contact with the vocal cords [9]. Second, the incidence of postoperative hoarseness was reported to directly correlate with the size of the endotracheal tube [3].…”