scholarly journals The Effect of Fiberoptic Bronchoscopy-guided Technique for Placement of a Left-sided Double-lumen Tube on the Intubation Performance Compared with the Conventional Method Using a Macintosh Laryngoscope

2020 ◽  
Vol 14 (1) ◽  
pp. 115-122
Author(s):  
Jung A. Lim ◽  
In-Young Kim ◽  
Sung Hye Byun
Keyword(s):  
Thoracic Surgery ◽  
Endotracheal Tube ◽  
Conventional Method ◽  
Macintosh Laryngoscope ◽  
Tube Placement ◽  
Fiberoptic Bronchoscope ◽  
Double Lumen ◽  
Double Lumen Endotracheal Tube ◽  
Endotracheal Tube Placement ◽  
Initial Placement

Background: The accurate placement of the double-lumen endotracheal tube is imperative for effective one-lung ventilation in thoracic surgery. Malpositioning and repositioning of a misplaced tube may cause excessive trauma. Objective: We hypothesized that the fiberoptic bronchoscope-guided method for double-lumen endotracheal tube placement would reduce the incidence of malpositioning as compared to the conventional method using the Macintosh laryngoscope. Methods: Fifty patients scheduled to undergo elective thoracic surgery were recruited and randomly assigned to the fiberoptic bronchoscope-guided [n=25; Group F] and conventional [n=25; Group C] method groups, according to the method of double-lumen endotracheal tube placement. The primary outcome was the incidence of double-lumen endotracheal tube malpositioning observed under the fiberoptic bronchoscope after initial placement. Secondary outcomes included the times for placement, confirmation, and total procedure of double-lumen endotracheal tube intubation. Results: The incidence of malpositioning after initial double-lumen endotracheal tube placement was significantly lower in Group F than in Group C (20.0% vs 68.0%). In addition, the time for placement was significantly higher in Group F than in Group C, and that for confirmation was significantly lower in Group F than in Group C. Conclusion: The fiberoptic bronchoscope-guided method for double-lumen endotracheal tube placement can reduce the incidence of malpositioning after initial placement and expedite the intubation process with a double-lumen endotracheal tube in thoracic surgery.

scholarly journals Iatrogenic Left Main Bronchus Injury following Atraumatic Double Lumen Endotracheal Tube Placement

2013 ◽  
Vol 2013 ◽  
pp. 1-3
Author(s):  
William R. Hartman ◽  
Michael Brown ◽  
James Hannon
Keyword(s):  
Endotracheal Tube ◽  
Main Bronchus ◽  
Left Main Bronchus ◽  
Double Lumen Tube ◽  
Tube Placement ◽  
Left Main ◽  
Double Lumen ◽  
Lumen Tube ◽  
Double Lumen Endotracheal Tube ◽  
Endotracheal Tube Placement

Tracheobronchial disruption is an uncommon but severe complication of double lumen endotracheal tube placement. The physical properties of a double lumen tube (large external diameter and length) make tracheobronchial injury more common than that associated with smaller single lumen endotracheal tubes. Here we present the case of an iatrogenic left main bronchus injury caused by placement of a double lumen tube in an otherwise unremarkable airway.

scholarly journals Changes in the Bronchial Cuff Pressure of Left-Sided Double-Lumen Endotracheal Tube by Lateral Positioning: A Prospective Observational Study

2021 ◽  
Vol 10 (8) ◽  
pp. 1590
Author(s):  
Jong-Hae Kim ◽  
Eugene Kim ◽  
In-Young Kim ◽  
Eun-Joo Choi ◽  
Sung-Hye Byun
Keyword(s):  
Thoracic Surgery ◽  
Endotracheal Tube ◽  
Primary Outcome ◽  
Cuff Pressure ◽  
Lateral Decubitus Position ◽  
Double Lumen ◽  
Double Lumen Endotracheal Tube ◽  
Bronchial Cuff ◽  
Lateral Decubitus ◽  
Lateral Positioning

Proper bronchial cuff pressure (BCP) is important when using a double-lumen endotracheal tube (DLT), especially in thoracic surgery. As positional change during endotracheal tube placement could alter cuff pressure, we aim to evaluate the change in BCP of DLT from the supine to the lateral decubitus position during thoracic surgery. A total of 69 patients aged 18–70 years who underwent elective lung surgery were recruited. BCP was measured at a series of time points in the supine and lateral decubitus positions after confirming the DLT placement. The primary outcome was change in the initial established BCP (BCPi), which is the maximum pressure at which the BCP did not exceed 40 cmH2O without air leak in the supine position, after lateral decubitus positioning. As the primary outcome, the BCPi increased from 25.4 ± 9.0 cmH2O in the supine position to 29.1 ± 12.2 cmH2O in the lateral decubitus position (p < 0.001). Out of the 69 participants, 43 and 26 patients underwent surgery in the left-lateral decubitus position (LLD group) and the right-lateral decubitus position (RLD group) respectively. In the LLD group, the BCPi increased significantly (p < 0.001) after lateral positioning and the beginning of surgery and the difference value, ∆BCPi, from supine to lateral position was significantly higher in the LLD group than in the RLD group (p = 0.034). Positional change from supine to lateral decubitus could increase the BCPi of DLT and the increase was significantly greater in LLD that in RLD.

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

2020 ◽  
Author(s):  
Yuji Kamimura ◽  
Toshiyuki Nakanishi ◽  
Aiji Sato(Boku) ◽  
Satoshi Osaga ◽  
Eisuke Kako ◽  
...  
Keyword(s):  
Propensity Score ◽  
Endotracheal Tube ◽  
Propensity Score Matching ◽  
Lung Resection ◽  
Macintosh Laryngoscope ◽  
University Hospital ◽  
Double Lumen ◽  
Double Lumen Endotracheal Tube ◽  
Single Lumen ◽  
One To One

Abstract Background: Postoperative hoarseness after general anesthesia is associated with patient discomfort and dissatisfaction. A recent large retrospective study showed that single-lumen endotracheal tube intubation by a trainee did not alter the incidence of postoperative pharyngeal symptoms compared with that by a senior anesthesiologist. However, little is known about the relationship between anesthesiologist experience and hoarseness after double-lumen endotracheal tube intubation. We tested the hypothesis that double-lumen endotracheal tube intubation by a trainee increases the incidence of postoperative hoarseness compared with that by a senior anesthesiologist.Methods: This retrospective observational study included patients who underwent lung resection from April 2015 to March 2018 in a university hospital. Patients underwent double-lumen endotracheal tube intubation with a Macintosh laryngoscope. We divided the patients into two groups: one group comprising patients whose tracheas were intubated by a trainee anesthesiologist and the other comprising those whose tracheas were intubated by a senior anesthesiologist. The primary outcome was the incidence of postoperative hoarseness 24 h after surgery. We collected data on postoperative hoarseness using a checklist of postanesthetic adverse events. One-to-one propensity score matching was performed. P values of <0.05 were considered statistically significant.Results: There were 256 eligible patients; 153 patients underwent intubation by trainee anesthesiologists, and the remaining 103 patients underwent intubation by senior anesthesiologists. The one-to-one propensity score matching generated 96 pairs of patients for the groups. The incidence of postoperative hoarseness 24 h after the surgery was significantly higher in patients whose tracheas were intubated by a trainee anesthesiologist than in those whose tracheas were intubated by a senior anesthesiologist (9.4% vs. 2.1%, respectively; P = 0.03).Conclusions: Double-lumen endotracheal tube intubation by trainee anesthesiologists increased the incidence of postoperative hoarseness 24 h after the surgery compared with intubation by senior anesthesiologists.

Lung Separation during Thoracic Surgery: Arndt Endobronchial Blocker® Versus Double-Lumen Endotracheal Tube

2002 ◽  
Vol 96 (Sup 2) ◽  
pp. A1316
Author(s):  
Volker Lischke ◽  
Stephan Mierdl ◽  
Klaus Westphal ◽  
Dirk Meininger ◽  
Christian Byhahn
Keyword(s):  
Thoracic Surgery ◽  
Endotracheal Tube ◽  
Double Lumen ◽  
Double Lumen Endotracheal Tube ◽  
Endobronchial Blocker

scholarly journals Effect of lateral positioning on the bronchial cuff pressure of a left-sided double-lumen endotracheal tube during thoracic surgery: study protocol for a prospective observational study

BMJ Open ◽  
2019 ◽  
Vol 9 (3) ◽  
pp. e026606
Author(s):  
Eugene Kim ◽  
In-Young Kim ◽  
Sung-Hye Byun
Keyword(s):  
Observational Study ◽  
Thoracic Surgery ◽  
Endotracheal Tube ◽  
Cuff Pressure ◽  
Air Leak ◽  
Double Lumen ◽  
Double Lumen Endotracheal Tube ◽  
Bronchial Cuff ◽  
Lateral Decubitus ◽  
Lateral Positioning

IntroductionCorrect pressure is important when using a double-lumen endotracheal tube (DLT), especially in thoracic surgery. An inadequate bronchial cuff pressure (BCP) can cause air leak and interfere with visualisation of the surgical field, whereas an excessive pressure BCP can lead to cuff-related complications. Based on several reports that cuff pressure could alter after a positional change when using an endotracheal tube, we hypothesise that a change from the supine position to the lateral decubitus position, which is essential for thoracic surgery, would affect the BCP of the DLT.Methods and analysisThis prospective, single-centre, observational study will enrol 74 patients aged 18–70 years undergoing elective lung surgery from September 2018 to April 2019. The primary outcome will be the change in the ‘initially established BCP’ (maximum BCP not exceeding 40 cm H2O with no air leak in the supine position) after lateral decubitus positioning. BCP and air leak will be assessed in each patient position during inflation of the cuff with air in 0.5 mL increments from 0 to 3 mL. Secondary outcomes will include the incidence of BCP exceeding 40 cm H2O after the initial established value and that of a change in the smallest bronchial cuff volume without air leak after a change to the lateral position. The relationship between the change in BCP and airway pressure, compliance and body mass index after lateral positioning will be investigated.Ethics and disseminationThe study will be conducted in accordance with the Declaration of Helsinki and supervised by the Daegu Catholic University Medical Center institutional review board (study approval number CR-18–111). All patients will receive information about the study and will need to provide written informed consent before enrolment. The results will be presented at an international meeting and published in a peer-reviewed journal.Trial registration numberNCT03656406; Pre-results.

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