Application of video laryngoscope combined with bronchial blocker and double-lumen tube in the standardized training of anesthesia for tracheal intubation / 中华医学教育探索杂志

Objective:To explore the comparative study of video laryngoscopy combined with bronchial blocker and video laryngoscopy combined with double-lumen tube in the teaching of endotracheal intubation in thoracic surgery in the standardized residency training of anesthesia.Methods:The trainees of the standardized residency training were randomly divided into control group and experimental group for clinical teaching, with 25 ones in each group. The experimental group was treated with visual laryngoscopy combined with bronchial blocker, while the control group was treated with visual laryngoscopy combined with double-lumen tube group. The intubation time, intubation success rate, positioning time, hemodynamic changes, and complication incidence during intubation, as well as student assessment results were recorded. GraphPad Prism 6.0 was used for t test and Chi-square test. Results:The time of endotracheal intubation [(95.3±10.1) vs. (137.5±13.5)] and positioning time [(100.8±11.7) vs. (155.4±15.3)] in the experimental group were both shorter than those of the control group ( P< 0.001), the hemodynamic changes in patients with immediate intubation were smaller ( P<0.001), the success rate of intubation was higher (92% vs. 68%) ( P<0.001), the complication incidence was lower ( P<0.001) and the students' performance was higher ( P<0.001). Conclusion:In the anesthesia teaching of thoracic surgery, bronchial blocker can reduce the time of endotracheal intubation, lower the hemodynamic changes during intubation, cut down the incidence of complications, improve the success rate of endotracheal intubation and enhance the confidence of students.

A new strategy in lung/lobe isolation in patients with a lung abscess or a previous lung resection using double lumen tubes combined with bronchial blockers

The combined use of a double?lumen tube and a bronchial blocker can be very helpful in two different clinical scenarios: (1) in isolating not only the contralateral lung, but also the lobe/s of the same lung in which the infected lobe must be resected, (2) in preventing/treating hypoxemia because of the presence of a contralateral lobectomy. A cardiothoracic anesthesiologist must expertise this technique to avoid complications during surgery.

Bronchial Blocker and Double?Lumen Endotracheal Tube Combination to Facilitate Lung Isolation during Esophagectomy

Lung isolation is an essential anesthetic technique utilized in thoracic surgeries. We present a patient undergoing esophagectomy that developed an iatrogenic injury to the left mainstem bronchus that damaged the bronchial cuff of a left?sided double?lumen endotracheal tube (DLETT). A bronchial blocker (BB) was placed in the tracheal lumen of the DLETT as a rescue method to facilitate continued lung isolation. This unusual combination of a DLETT and a BB proved useful once the bronchial cuff was compromised and may serve as a viable solution to maintain lung isolation in similar circumstances

Comparison of application of bronchial blocker and tracheal catheter on one-lung ventilation in infants / 上海交通大学学报（医学版）

Objective • To analyze the clinical application of bronchial blocker and tracheal catheter in infants with one-lung ventilation. Methods • Forty patients in Children's Hospital, Shanghai Jiao Tong University from Jul. 2017 to Jun. 2018 undergoing elective thoracoscopic surgery were randomized into two groups by random number table method, i.e. group A (bronchial blocker) and group B (tracheal catheter), with twenty cases in each group. In the two groups, one-lung ventilation was achieved by blocking bronchial blocker and tracheal catheter, respectively. All operations were performed by one skilled anesthesiologist. The clinical occurrences of the two groups were recorded, including placement and positioning time, immediate hemodynamic indexes before and after intubation, the number of successful cases of one-lung ventilation, the number of intraoperative shifts cases and postoperative hoarseness cases. Also, the ventilation indexes of the two groups was recorded, including tidal volume (VT), peak airway pressure (Ppeak) and intraoperative lung collapse after five minutes of one-lung ventilation. Results • Compared with group B, placement and positioning time in group A was shorter (P=0.022), the number of successful rates of one-lung ventilation in group A was bigger (P=0.024), the number of intraoperative shifts cases in group A was less (P=0.042), and intraoperative lung collapse after five minutes of one-lung ventilation in group A was better (P=0.030). There were no significant differences in immediate hemodynamic indexes before and after intubation, VT and Ppeak after five minutes of one-lung ventilation, and the number of postoperative hoarseness cases. Conclusion • Extraluminal placement of bronchial blocker used in infants has an advantages in terms of the intubation time, the success rate, and the less complications compared with the tracheal tube, which can achieve more effective one-lung ventilation and better clinical application value.

Selective lobar blockade with a Coopdech blocker combined with a double-lumen endotracheal tube for lung metastases resection by laser / Bloqueio lobar seletivo com um bloqueador Coopdech combinado com um tubo endotraqueal de duplo lúmen para ressecção de metástases pulmonares com laser

Abstract In recent years, laser resection of lung metastases has been established as the standard procedure worldwide. To avoid airway fire, it is necessary to collapse the surgical lung. The selective lobar bronchial blockade is a technique that allows one-lung ventilation while the operated lobe is collapsed in patients with previous pulmonary resection requiring subsequent resection or with limited pulmonary reserve. We report a clinical case about our experience of a selective lobar bronchial blockade technique with a bronchial blocker (Coopdech endobronchial blocker) that was employed successfully with a double-lumen endotracheal tube in a patient with previous contralateral pulmonary resection who was scheduled for atypical resections of pulmonary metastases by laser. We selectively blocked the right intermediate bronchus for management of hypoxemia during one-lung ventilation. This technique provided adequate ventilation and oxygenation during surgery, avoiding the need of two-lung ventilation during lung metastases resection by laser. Conclusion: This case shows that if a properly positioned double-lumen tube was already in place and the patient does not tolerate one-lung ventilation because of hypoxemia, it would be possible to provide selective lobar blockade by placing a bronchial blocker through the lumen of the double-lumen tube, avoiding the use of continuous positive airway pressure during laser surgery. This technique does not disturb the operative field or interrupt the operative procedure during resection by laser, which would occur during two-lung ventilation or used of continuous positive airway pressure.

Resumo Nos últimos anos, a ressecção de metástases pulmonares com o uso de laser foi estabelecida como o procedimento padrão em todo o mundo. Para evitar queimadura das vias aéreas, o colapso cirúrgico do pulmão é necessário. O bloqueio brônquico seletivo é uma técnica que permite a ventilação de um lobo, enquanto o lobo operado é colapsado nos pacientes com ressecção pulmonar anterior que requerem ressecção subsequente ou que possuem reserva pulmonar limitada. Relatamos um caso clínico de nossa experiência com a técnica de bloqueio brônquico seletivo com bloqueador brônquico (bloqueador endobrônquico Coopdech), usado com sucesso com um tubo endotraqueal de duplo lúmen em um paciente com ressecção pulmonar contralateral prévia, agendado para ressecção atípica de metástases pulmonares com o uso de laser. Seletivamente bloqueamos o brônquio intermediário direito para o controle de hipoxemia durante a ventilação monopulmonar. Essa técnica proporcionou ventilação e oxigenação adequadas durante a cirurgia, evitando a necessidade de ventilar os dois pulmões durante a ressecção de metástases pulmonares com o uso de laser. Conclusão: Este caso mostra que, se um tubo de duplo lume estiver corretamente posicionado e o paciente não tolerar a ventilação monopulmonar devido à hipoxemia, seria possível fornecer bloqueio lobar seletivo com a colocação de um bloqueador brônquico através do lume do tubo de duplo lume, evitando o uso de pressão positiva contínua de vias aéreas (PPCVA) durante a cirurgia a laser. Essa técnica não interfere no campo operatório ou interrompe o procedimento durante a ressecção por laser, que poderia ocorrer durante a ventilação dos dois pulmões ou uso de PPCVA.

Effect of endotracheal tube depth on efficacy of bronchial blocker when used for one-lung ventilation / 中华麻醉学杂志

Objective To evaluate the effect of the endotracheal tube (ETT) depth on the efficacy of bronchial blocker when used for one-lung ventilation.Methods Sixty patients of both sexes,aged 46-78 yr,weighing 48-85 kg,with body mass index＜30 kg/m2,scheduled for elective thoracotomy requiring one-lung ventilation,were divided into 2 groups (n =30 each) using a random number table:the distance between the tip of ETT and the carina was 3 cm group (group Ⅰ) and the ETT cuff was placed at 2 cm below the glottis group (group Ⅱ).The bronchial blocker was inserted under the guidance of a fiberoptic bronchoscope.The ETT depth,time to bronchial blocker position,development of bronchial blocker displacement and increase in airway peak pressure,degree of lung collapse,severity of postoperative tracheal mucous membrane injury and development of sore throat and hoarseness were recorded.Results Compared with group Ⅰ,the ETT depth was significantly shallower,the time to bronchial blocker position was shortened,postoperative tracheal mucous membrane injury was attenuated (P＜0.05 or 0.01),and no significant change was found in the incidence of bronchial blocker displacement and increase in airway peak pressure,degree of lung collapse or incidence of sore throat and hoarseness in group Ⅱ (P＞0.05).Conclusion The ETT depth the ETT cuff placed at 2 cm below the glottis can improve the efficacy of bronchial blocker when used for one-lung ventilation.

Effect of different one-lung ventilation strategies on vedio-assisted atrial fibrillation ablation / 临床麻醉学杂志

Objective To compare clinical effect and safety of left-double-lumen tube and bron-chial blocker in vedio-assisted atrial fibrillation ablation.Methods Forty-eight patients,26 males and 22 females,aged 45-65 years,ASA physical status Ⅰ or Ⅱ,who underwent vedio-assisted atrial fi-brillation ablation were randomly divided into double-lumen tube (group A)and bronchial blocker (group B),with 24 patients in each group.The tube type of group A was left-double-lumen tube. Bronchofiberscope was used for location in every patient.The mean artery pressure (MAP)and heart rate (HR)before intubation,intubation positioning time,peak airway pressure (Ppeak)after 5 min of one-lung ventilation,lung collapse,incidences of hoarseness,pharyngalgia and choke were ob-served.Results Intubation positioning time between two groups was not statistically significant. MAP and HR were significantly increased at intubation positioning time in both groups,to be specif-ic,they were significantly in group A than in group B (P <0.05 ).When left lungs blocked,Ppeak and qualities of lung collapse were not statistically different between the two groups.When right lungs blocked,group A was higher than that in group B (P < 0.05 ).Cough,hoarseness and sore throat were more frequently seen in group A than in group B.Conclusion Both double-lumen tube and bron-chial blocker can be used in video-assisted atrial fibrillation ablation with satisfying effects.As for the quality of lung isolation,double-lumen tube was better than bronchial blocker.However,compared with bronchial blocker,double-lumen tube results in more unstable hemodynamics and higher occur-rence of hoarseness,pharyngalgia and choke.

An innovative way to reinsert dislodged Arndt blocker using urological glide wire.

The Arndt blocker is positioned in the desired bronchus using a wire loop which couples the blocker with a fiberoptic bronchoscope (FOB). The wire loop once removed cannot be reinserted in 5F and 7F blockers making repositioning of the blocker difficult. A 34-year-old female was to undergo left thoracotomy followed by laparoscopic cholecystectomy. The left lung was isolated with a 7F Arndt bronchial blocker. During one‑lung ventilation, the wire loop was removed for oxygen insufflation. There was loss of lung isolation during the procedure and dislodgement of the blocker was confirmed by FOB. The initial attempts to reintroduce the blocker into the left main bronchus failed. An alternative technique using a glide wire was attempted which resulted in successful reintroduction of the Arndt blocker. The 0.032 inch zebra glide wire may be effectively used to reposition a dislodged Arndt blocker if the wire loop has been removed.

A randomized trial to assess the utility of preintubation adult fiberoptic bronchoscope assessment in patients for thoracic surgery requiring one‑lung ventilation.

Background: Confirmation of placement of Double lumen endobronchial tubes (DLETT) and bronchial blockers (BBs) with the pediatric fiberoptic bronchoscope (FOB) is the most preferred practice worldwide. Most centers possess standard adult FOBs, some, particularly in developing countries might not have access to the pediatric‑sized devices. We have evaluated the role of preintubation airway assessment using the former, measuring the distance from the incisors to the carina and from carina to the left and right upper lobe bronchus in deciding the depth of insertion of the lung isolation device. Methods: The study was a randomized, controlled, double‑blind trial consisting of 84 patients (all >18 years) undergoing thoracic surgery over a 12‑month period. In the study group (n = 38), measurements obtained during FOB with the adult bronchoscope decided the depth of insertion of the lung isolation device. In the control group (n = 46), DLETTs and BBs were placed blindly followed by clinical confirmation by auscultation. Selection of the type and size of the lung isolation device was at the discretion of the anesthesiologist conducting the case. In all cases, pediatric FOB was used to confirm accurate placement of devices. Results: Of 84 patients (DLETT used in 76 patients; BB used in 8 patients), preintubation airway measurements significantly improved the success rate of optimal placement of lung isolation device from 25% (11/44) to 50% (18/36) (P = 0.04). Our incidence of failed device placement at initial insertion was 4.7% (4/84). Incidence of malposition was 10% (8/80) with 4 cases in each group. The incidence of suboptimal placement was lower in the study group at 38.9% (14/36) versus 65.9% (29/44). Conclusions: Preintubation airway measurements with the adult FOB reduces airway manipulations and improves the success rate of optimal placement of DLETT and BB.

Experience of hemostasis in tracheal bleeding very close to the carina by the bronchial blocker: a case report / 대한마취과학회지

Massive hemoptysis is respiratory compromise which should be managed as a life-threatening condition. In our case, the bronchial blocker played a role in hemostasis of tracheal bleeding very close to the carina and prevented further spillage into the contralateral lung. Right-sided one-lung isolation in an 87-year-old female, who received cardiopulmonary resuscitation due to myocardial infarction, was requested due to hemoptysis. Right-sided bronchial bleeding was suspected on auscultation, but esophageal and tracheal bleeding due to violent intubation with a stylet was also considered. We attempted one-lung isolation with the bronchial blocker. The bronchial blocker was inadvertently advanced to the left mainstem bronchus, but the inflated balloon of the bronchial blocker compressed the site of bleeding, which was within 1 cm proximal and left posterior to the carina. Tracheal bleeding stopped, and we confirmed that hemostasis was achieved with the balloon of the bronchial blocker using a fiberoptic bronchoscope.

Management of traumatic pneumothorax with massive air leakage: role of a bronchial blocker: a case report / 대한마취과학회지

Massive air leakage through a lacerated lung produces inadequate ventilation and hypoxemia. Tube exchange from a single to double lumen endotracheal tube (DLT), and lung separation to maintain oxygenation, are challenging for seriously injured patients. In this case report, we aim to describe how a bronchial blocker (BB) makes it easier to perform a lung separation in this situation; it also increases the overall safety of the procedure. A 35-year-old female (163 cm, 47 kg) suffered from blunt chest trauma due to a traffic accident; the accident caused right-sided lung laceration with massive air leakage. Paradoxically, positive ventilation worsened SaO2 and leakage increased through a chest tube. We introduced BB while the patient was still awake: Left-side one-lung ventilation (OLV) was established and anesthesia was induced. After PaO2 was maximized with OLV, we changed the endotracheal tube to DLT without a hypoxic event. By BB placement, we maintained PaO2 at a secure level, conducted mechanical ventilation and exchanged the tube without deterioration.

Accidental avulsion of the cuff after one-lung ventilation by using the Coopdech bronchial blocker: A case report

A variety of anesthetic equipment has been introduced for one-lung ventilation (OLV) during video-assisted thoracoscopic surgeries. A double-lumen endobronchial tube or bronchial blockers are the most common techniques used for achieving OLV. We herein describe a case of general anesthesia requiring both the OLV and two-lung ventilation with a Coopdech bronchial blocker and a single-lumen endotracheal tube. A 43-year-old woman is being scheduled to undertake mediastinal mass removal and tonsillectomy. After performing tonsillectomy by using an endotracheal tube, a Coopdech bronchial blocker is being inserted into her right bronchus for video-assisted thoracoscopic surgery. After her surgery, we have encountered resistance while carefully trying to remove the bronchial blocker. When using fiberoptic bronchoscopy, we have observed that the cuff was being avulsed, which could be removed without difficulty. We thus describe a case in which the balloon cuff was detached and retained in the right bronchus.

Right upper lobe tracheal bronchus: anesthetic challenge in one-lung ventilated patients: A report of three cases / 대한마취과학회지

Tracheal bronchus (TB) is an aberrant, accessary or ectopic bronchus arising almost exclusively from the right side of the tracheal wall above the carina. In our center, 673 bronchoscopic examinations were performed from 2009 to 2011 in patients undergoing one lung ventilation (OLV) and 3 TB were found. The incidence of a TB at bronchoscopy was 0.45% in our research, which is consistent with the reported incidence range from 0.1-5%. The clinician should consider the possibility of anomalous right upper lobe bronchus and perform bronchoscopy prior to the right bronchial blocker insertion, when left-sided OLV using bronchial blocker is planned. Also, for the patient with TB, a double lumen tube insertion is recommended than a blocker insertion to achieve OLV completely.

Contrast in respiratory mechanics and blood gas between bronchial blocker and double lumen tube in one lung ventilation / 中国医师进修杂志

Objective To compare the influences between bronchial blocker (BB) and double lumen tube (DLT) in respiratory mechanics and blood gas in one lung ventilation. Methods Thirty-six patients undergoing pulmonary lobectomy or radical operation of esophageal carcinoma were randomized into group BB (17 cases) and group DLT (19 cases). In group BB,BB was intubated under the guidance of a fibreoptic bronchoscope after intubation of single lumen tube; while in group DLT, the position of the tube was confirmed using fibreoptic bronchoscopy after intubation. The peek airway pressure (Pmax) and pulmonary dynamic compliance (CLdyn) during double lung ventilation and one lung ventilation were recorded in recumbent position. Blood samples were taken from, radial artery 20 min after one lung ventilation for blood gas analysis,partial pressure of oxygen in artery(PaO2), partial pressure of carbon dioxide in artery(PaCO2), saturation of arterial blood oxygen (SaO2) were recorded. Results No significant difference was found in Pmax and CLdyn between two groups during double lung ventilation,but Pmax was significantly lower in group BB [(21.00 ± 3.59) cm H2O,1 cm H2O = 0.098 kPa] than that in group DLT [(26.89 ±4.21) cm H2O] (P＜0.05), and CLdyn was greater in group BB [(28.10 ±6.24) ml/cm H2O] than that in group DLT [(24.00±7.13) ml/cm H2O ] (P ＜ 0.05); there were no significant differences in PaO2, PaCO2, SaO2 betweentwo groups during one lung ventilation (P＞ 0.05). Conclusion The influence to respiratory mechanics in one lung ventilation is smaller using BB than using DLT, BB has blocker well applicable value in clinics.

One-lung ventilation with a bronchial blocker through a single-lumen endotracheal tube in a small woman: A case report

One-lung ventilation with a double-lumen endotracheal tube or a Univent(R) tube may be difficult or dangerous in small patients, children, and patients with anatomic abnormalities of the airway. The use of a bronchial blocker through a single-lumen endotracheal tube has been used successfully in such situations. A 69-year-old woman was scheduled for Ivor-Lewis operation and right upper lobectomy. She could not be intubated with a internal diameter 6.0 mm Univent(R) tube owing to narrow diameter of the vocal cord. We report a successful one-lung ventilation using a Uniblocker(R) through an adult-size single-lumen endotracheal tube in a small woman, who needed postoperative ventilator care.

Comparison of the Effects among Three Methods of Bronchial Blockade in One Lung Ventilation / 대한마취과학회지

BACKGROUND: This study compared the modified BronchoCath double-lumen endotracheal tube (DLT) with the Univent bronchial blocker and Arndt's wire-guided endobronchial blocker (WEB) to determine whether there were objective advantages of one over the other during anesthesia with one lung ventilation. METHODS: Forty five patients having either thoracic or esophageal procedures were randomly assigned to one of three groups. Fifteen patients received a left-side DLT, 15 patients received a Univent tube, and 15 patients received a WEB. The following were studied: 1) time required to position each tube until satisfactory placement was achieved, 2) time required until lung collapse, 3) frequency of malpositions after initial placement with fiberoptic bronchoscopy, 4)surgical exposure ranked by surgeons blinded to type of tube used. RESULTS: Statistically significant differences were observed in time required to place the tube or blocker between the WEB (263.6 +/- 76.0 s), DLT (146.4 +/- 57.7 s, I < 0.0001) and Univent tubes (193.8 +/- 72.4 s, P = 0.0130). There were no significant differences in time to lung collapse, the frequency of malposition or surgical exposure. CONCLUSIONS: We conclude that the DLT, Univent tube, and WEB are useful for one lung anesthesia but it takes longer for the WEB to be placed safely than to place a DLT or Univent tube. The selection between the three tubes depends on type of surgery, difficulty of intubation, and familiarity of each tube by the anesthesiologist.

A Study of a Separated Bronchial Blocker / 대한마취과학회지

BACKGROUND: Compared with blockers mounted on the endotracheal tube, (a conjugated blocker), studies about blockers that are independent of a single-lumen tube, (a separated blocker) are rare. This study's object was to find several characteristics about these new blockers. METHODS: We compared the peak and plateau airway pressures in intubated patients (n = 30) with, (group EB) and without, (group E) blockers. We measured the depth of the blockers and the pressures of the balloon of the blockers. Balloon pressures were measured twice outside and inside of the E-tube with 7 ml of air. All of these measurements were done in the supine position with 1 L/min flow rate. The frequency of malposition, the score of the lung collapse, and bronchial mucosa change were checked thereafter. RESULTS: The peak airway pressures of group EB were significantly higher than those of group E (p < 0.05). However, the plateau pressures of both groups were not different. The depth of the blockers was 52.0 +/- 1.8 cm, and the balloon pressures of the blockers were 124 +/- 22 and 139 +/- 20 mmHg, respectively. Six patients needed additional bronchoscopy because of malposition. The lung collapse score was good in 17 patients, fair in 10 patients, and poor in 3 patients. There was not any severe bronchial mucosa damage. CONCLUSIONS: Understanding the characteristics of these new blockers, we can consider the use of them in some situations in which the use of a double-lumen tube is impossible or inconvenient.

Failure to Collapse Right Lung Using a Single Lumen Tube with Bronchial Blocker in a Patient with Congenital Right Tracheal Bronchus / 대한마취과학회지

Tracheal bronchus is a congenital anomaly usually originating from the right lateral wall of the trachea. It is usually found within 2 cm above the carina. Most cases of tracheal bronchus are asymptomatic and detected only incidentally on bronchoscopy or radiologic examination. Anatomic abnormalities of the airway are particular concern to anesthesiologists. We report a case in which an undiagnosed tracheal bronchus interfered with isolation of the right lung with a single lumen tube with bronchial blocker (Univent tube). Bronchoscopic examination showed the presence of an opening approximately 0.5 cm proximal to the carina. We withdrew the Univent tube and replaced it with a left-sided, 37 F double-lumen endotracheal tube. Right lung isolation was done satisfactorily and allowed the completion of the procedure.

Clinical Evaluation of One Lung Ventilation during General Anesthesia / 대한구급학회지

BACKGROUND: Separation of two lungs during anesthesia is necessary for the purpose of isolation of one lung from the other to prevent spillage or contamination and facilitating surgical exposure by collapsing the lung in the operative hemithorax. Several techniques are available for providing one-lung anesthesia. This study was performed to evaluate which technique is favored and why it is favored for one-lung ventilation. METHODS: We studied 70 patients scheduled for thoracic surgery aided by collapse of the ipsilateral lung. We analyzed frequency of each technique, efficacy of lung collapse, adequacy of one-lung ventilation, blood gases and complications. RESULTS: In the 63 patients out of 70 patients, the double-lumen tubes were used. Left-sided were used in 57 patients and right-sided were used in 6 patients. There were 3 complications: tracheal rupture, right bronchial rupture and post-operative edema of vocal cords. Bronchial blockers were inserted in 7 patients. It was failed in two cases. Ventilation and oxygenation were respectively good in all patients. CONCLUSIONS: We favored the double-lumen endotrachial tube than Univent blocker. Malposition was frequently seen with the Univent and serious complication was occasionally seen with the double-lumen tube. However surgical exposure and oxygenation was provided with any method, when position was corrected adequately.

Comparison of a Double Lumen Endobronchial Tube with a Single Lumen Tube with Bronchial Blocker for One Lung Anesthesia / 대한마취과학회지

BACKGROUND: Double lumen endobronchial tube and single lumen tube with bronchial blocker are most frequently used tubes for one lung anesthesia. This study compared the double lumen endobronchial tube with the single lumen tube with bronchial blocker to determine whether there were objective advantages of one over the other during one lung anesthesia. METHODS: Sixty patients were randomly assigned to one of two groups. Thirty patients were intubated with a left-sided double lumen endobronchial tube, and thirty patients were intubated with a single lumen tube with bronchial blocker. Each group was subdivided into two groups with a person intubating (i,e, certified anesthesiologist or resident) to compare the easiness of intubation according to the type of tube. Fiberoptic flexible bronchoscope was used in all patients. The following were studied 1) time required to position each tube until satisfactory placement achieved, 2) frequency of malposition after initial placement with fiberoptic bronchoscopy, 3) surgical exposure ranked by surgeons blinded to type of tube used, 4) easiness of tracheobronchial toilet (TBT). RESULTS: 1) Statistically significant differences were observed in time required to place each tube by resident(double lumen tube 5.73+/- 0.48 min. versus single lumen tube with bronchial blocker 4.18+/-0.70 min (P<0.05) and in easiness of TBT (double lumen tube 18/30 versus single lumen tube with bronchial blocker 27/30) (P<0.05). 2) No differences were observed in time required to position each tube by anesthesiologist, the frequency of malposition and surgical exposure. CONCLUSIONS: Single lumen tube with bronchial blocker is better in easiness of intubation by resident and in easiness of TBT than double lumen endobronchial tube. But the selection of two tubes depends upon type of surgery and familiarity of each tube by the anesthesiologist.