Effect of assessing the right bronchus orifice preintubation by bronchoscopy on adjusting the position of right double-lumen endobronchial tube / 解剖学报

Objective: To investigate the clinical value of examining the anatomical position of right superior bronchus orifice preintubation by bronchoscopy on adjusting the position of right double-lumen endobronchial tube (R-DLT). Methods: One hundred and sixty adult patients who were scheduled to intubate with R-DLT undergoing thoracic surgery were randomly assigned into two groups (n = 80 per group); experimental group and control group. All patients were received intravenous anesthetics for induction. The length of right main bronchus and the position of right superior bronchus orifice in the transverse section of right main bronchus were measured prior to intubation by bronchoscopy in experimental group. The R-DLT was inserted into right bronchus by the conventional method and then adjusted the position by bronchoscopy in two groups. Bronchoscopy was performed through the tracheal lumen to ensure that the endobronchial portion of the DLT was in the right bronchus. The blue endobronchial cuff was just seen below the carina. In addition, lifted or inserted and twisted the tube properly according to the data measured in the experimental group. The relative position of orifices of the tube and the right upper lobe bronchus was assessed by bronchoscopy in the two groups. The R-DLT was considered as effective preliminary location if right superior bronchus orifice was partly seen through the lateral orifice of R-DLT. The position of R-DLT was further adjusted till the three orifices of segmental bronchi were seen. Results In experimental group, the length of right main bronchus was (2. 29 ± 0. 58) cm which was shorter than 1 cm in 2 cases (2.5%). The central angle in the transverse section of right main bronchus between the central point of right superior bronchus orifice to 12 o' clock position was (94. 5 ± 8. 3) " which was smaller than 75° or bigger than 105° in 4 cases (5. 0%) in total. The number of effective preliminary location of R-DLT was 77(96. 3%) in experimental group, and 62 (77.5%) in control group, which showed significant difference between the two groups(P < 0. 05). There was 1 case (1. 25%) failed intubation in each group, because of short distance within 1cm between right superior bronchus orifice and tracheal carina. Conclusion: Examining the anatomical position of right superior bronchus orifice preintubation is helpful to improve effective preliminary location of R-DLT, and it is beneficial to find out anatomical variation and select appropriate airway tube.

Comparison of domestic infantile type video intubationscope and stethoscope in positioning of double-lumen endobronchial tube / 中国内镜杂志

Objective To compare the effect of the domestic infantile type video intubationscope (VIS) and stethoscope in positioning of double-lumen endobronchial tube (DLT). Methods 100 cases of patients underwent elective thoracic surgery requiring single lung ventilation were randomly divided into two groups: domestic infantile type video intubationscope group (group V) and stethoscope group (group S), with 50 cases in each. After intubating with a DLT, the positions of DLT were judged and adjusted by VIS (group V) and stethoscope (group S) respectively, and then reviewed by fiberoptic bronchoscopy (FOB), the positioning time and accuracy were recorded. Results Comparing with the group S, the positioning time of DLT was significantly shorter and the total positioning accuracy of DLT was significantly higher in group V (P < 0.05). Conclusion It is easy and quickly, high accuracy with domestic infantile type video intubationscope in positioning of DLT, which is worthy of clinical popularization and application.

Comparison of domestic infantile type video intubationscope and stethoscope in positioning of double-lumen endobronchial tube / 中国内镜杂志

Objective To compare the effect of the domestic infantile type video intubationscope (VIS) and stethoscope in positioning of double-lumen endobronchial tube (DLT). Methods 100 cases of patients underwent elective thoracic surgery requiring single lung ventilation were randomly divided into two groups: domestic infantile type video intubationscope group (group V) and stethoscope group (group S), with 50 cases in each. After intubating with a DLT, the positions of DLT were judged and adjusted by VIS (group V) and stethoscope (group S) respectively, and then reviewed by fiberoptic bronchoscopy (FOB), the positioning time and accuracy were recorded. Results Comparing with the group S, the positioning time of DLT was significantly shorter and the total positioning accuracy of DLT was significantly higher in group V (P < 0.05). Conclusion It is easy and quickly, high accuracy with domestic infantile type video intubationscope in positioning of DLT, which is worthy of clinical popularization and application.

Application value of fibrobronchoscope test in process of whole lung lavage / 重庆医学

Objective To analyze the clinical experience of double lumen endobronchial tube intubation in 41 cases of whole lung lavage .Methods Forty‐one patients with whole lung lavage in our hospital from February 2010 to February 2015 were retro‐spectively analyzed .The effect of bronchoscopy and auscultation location method were explored after double‐lumen endobronchial intubation in whole‐lung lavage .Results Among 41 cases ,39 cases were successfully located by using the auscultation location ,and other 2 cases were successfully positioned by using the bronchoscopy position after repeatedly auscultation location method resulting in lung isolation failure .The catheter depth in 19 cases was adjusted after using bronchoscopy ,and then double lung was isolated well and lavage was successfully conducted .Conclusion The prerequisite for success of whole lung lavage is accurate position of double‐lumen endobronchial tube .Bronchoscopy look positioning has become the gold standard of double‐lumen endobronchial tube position .

Double Lumen Endobronchial Tube Malposition Due to Enlargement of Paratracheal Lymph Node / 계명의대학술지

Double lumen endobronchial tube (DLT) is used for lung separation in the surgical patients undergoing thoracic and mediastinal surgery. The use of DLT can lead to potential problems such as tube malposition and airway trauma. DLT can be placed in the inappropriate position due to abnormal and distorted anatomy of trachea or bronchus. We report a case of right main bronchial insertion of left-sided DLT by enlargement of paratracheal lymph node not detected in preoperative evaluations for 10 days.

Left mainstem bronchial rupture during one-lung ventilation with Robertshaw double lumen endobronchial tube: A case report / 대한마취과학회지

Lung separation using a double-lumen endobronchial tube is necessary for video assisted thoracoscopy (VATs). Bronchial rupture after intubation with a double-lumen endobronchial tube has been rarely reported. We report a case of a 70-year-old man who had solitary pulmonary nodule in his right upper lobe. He was intubated with a left-sided Robertshaw double-lumen endobronchial tube. He underwent a VATs right upper lobectomy with the one-lung ventilation of left lung. During the operation, the rupture of the left mainstem bronchus was detected. Immediately, the thoracotomy was performed and the ruptured left mainstem bronchus was repaired with absorbable sutures (vicryl). Seven days later he had a bronchoscopy to examine the left mainstem bronchus. There was no evidence of the bleeding, leakage and inflammation. Subsequent course was uneventful. Tracheobronchial injuries related to the double-lumen endobronchial tube are discussed.

Positioning of double lumen endobronchial tube by three combined ethods with fibroptic bronchoscope / 临床麻醉学杂志

Objective To observe the correctly positioning rate of left-sided double lumen endobronchial tube by combined adjustment of auscultation,PETCO2 and airway pressure changes.Methods Sixty adult patients undergoing thoracic surgery were intubated with Robertshaw DLTs. DLT position is checked and adjusted by fiberoptic bronchoscope（FOB）. Results In the supine position,successful intubation is 57 cases by three combined methods,one of cases is shallower,two of cases are deeper,satisfactory rate is 95 percents;In the lateral decubitus position,successful intobution is 56 cases by three combined methods,two of cases is shallower,two of cases are deeper,satisfactory rate is 93.4 percents.Conclusion Three combined methods that are simple,reliable can be used repeatedly during postural changes without increasing the opportunities for injury,it is clinically a very good approach,but the absolute scope of safety is very small,FOB is necessary for positioning.

Predicting the Depth of Insertion of Left-sided Double-Lumen Endotrachial Tubes in Koreans

BACKGROUND: Proper positioning of a double-lumen endobronchial tube is very important for lung isolation. This is best achieved by using a fiberoptic bronchoscope. Yet it is also important to predict the proper length when performing bronchoscopy is not possibe. In a previous report, the ideal depth of insertion of the left-sided double lumen endobronchial tube (DLT) was significantly correlated with the patient's height and the clavicular-to-carinal distance of the trachea. The aim of our study is to see whether that result can be applied to Koreans or not. METHODS: Forty eight patients who undergoing one lung ventilation (OLV) were intubated with a left-sided DLT. After proper positioning was achieved by bronchoscopy, we measured the depth of the tube at the upper incisor. Multiple linear regression analysis was done to determine the correlation of the depth of insertion with other factors. RESULTS: In Koreans, the depth of insertion was 9.216 + 0.104 x height + 1.797 x gender (male = 1, female = 0, R = 0.912, P = 0.003). CONCLUSIONS: In Koreans, the depth of insertion was only correlated with the gender and height of the patient, but not with the clavicle-to-carinal distance.

The Lengths of the Left and Right Mainstem Bronchi Measured by Computed Tomography with Minimum Intensity Projection in Korean Adults / 대한마취과학회지

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.

Comparison of a Silicon Double-Lumen Endobronchial Tube (Silbroncho(R)) with a Polyvinyl Chloride Tube (Broncho-Cath(R)) in Right-Side Thoracic Surgery / 대한마취과학회지

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(R)) with a polyvinyl chloride tube (Broncho-Cath(R)) to determine whether Silbroncho(R) 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(R) DLT and 21 patients received a Silbroncho(R) 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(R) vs Silbroncho(R), respectively). After position change, the incidence of DLT displacement in the Silbroncho(R) group (4.8%) was lower (P 0.05). CONCLUSIONS: Our results suggest that Silbroncho(R) can reduce the incidence of DLT displacement because of the small-sized bronchial cuff, which is located more distally than the Broncho-Cath(R) cuff. We conclude that Silbroncho(R) is superior to Broncho- Cath(R) for one lung ventilation during thoracic surgery.

The Resting Volume of the Bronchial Cuff of the Left-sided Double-lumen Tube and the Diameter of the Left Mainstem Bronchus Indicated for Each Double-lumen Tube Size / 대한마취과학회지

BACKGROUND: The purposes of this study were to assess the resting volume of the modified bronchial cuff of left-sided double-lumen bronchial tubes (DLT) and to determine the maximum range of the mainstem bronchial diameter indicated for DLT. METHODS: Left-sided DLTs (Broncho-Cath(R)) of 35-41 Fr (n = 5 each) were used for the study. The cuff was inflated with air in 0.5-ml increments to a volume of 5 ml and the corresponding cuff pressure was recorded. The smallest cuff volume, beyond which a 0.5 ml increase resulted in more than 10 mm Hg increase in cuff pressure, was considered to be the resting volume of that cuff. The resting volume was also calculated by differentiation on the fitted curve. The minimum required bronchial diameter was considered to be the reported OD of the bronchial tube and the maximum diameter was the measured OD of the bronchial cuff at a cuff pressure of 30 mmHg, which was measured with a precision caliper (0.1 mm intervals) at the midcuff level. RESULTS: The resting volume of the bronchial cuff, measured both traditionally and using the curve fitting analysis, were comparable. A DLT of any size > or = 35 Fr can be used for a bronchus with a diameter of 10.7-20.6 mm. CONCLUSIONS: There were extensive overlaps in the range of bronchial diameters indicated for each DLT size. Contrary to a common belief, the upper limits of the bronchial diameters indicated for all the DLTs > or = 35 Fr seemed to be the same regardless of the DLT size.

Displacement of a Double - Lumen Endobronchial Tube from Left to Right Bronchus during Surgical Dissection: A case report / 대한마취과학회지

Correct positioning of a double-lumen endobronchial tube (DLT) is essential for adequate ventilation, oxygenation, and lung separation during one-lung anesthesia. The displacement of a DLT by surgical manipulation, coughing, movements, or patient position changes have been reported. We experienced displacement of a left-sided DLT into the right bronchus during hilar dissection for carina sleeve right upper lobectomy in a 60-yr-old male patient. We emphasize the possibility of DLT dislocation during hilar dissection, so careful attention must be carried.

Some problems on application of double-lumen endotraeheal tube / 医疗卫生装备

The double-lumen endobronchial tubes are usually applied to the anesthesia of wet lung operation for the isolation of both lungs during anesthesia and one-lung ventilation.Many young physicians of the department and on-the-anesthesia training doctors are very interested in the intubatton.According to the past teaching experiences,some opinions are given in such aspects as the tube standard,pre-checking,estimation of the intubation depth and the significance of monitoring the airway resistance.These basic considerations are always easily overlooked by some young anesthetists.

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.

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.

Anesthetic Management for Sequential Bronchoalveolar Lavage in a Patient with Pulmonary Alveolar Proteinosis: A case report / 대한구급학회지

Pulmonary alveolar proteinosis is a rare disease of unknown etiology characterized by the remittent or progressive accumulation of lipid-rich proteinaceous material within the alveolar space in the absence of inflammatory response. The removal of lipoproteinaceous material from the alveolar can the only means of effectively treating the progressive hypoxemia in pulmonary alveolar proteinosis. Bronchoalveolar lavage using a double-lumen endotracheal tube is an accepted modality for treatment of pulmonary alveolar proteinosis. We had utilized sequential bronchoalveolar lavage successfully for the treatment of a 51 year-old male patient with pulmonary alveolar proteinosis. There was no hypoxemia and unstable hemodynamics during the procedure. We conclude that the procedure will be safely performed by careful monitoring.

The Incidence of Sore Throat and Hoarseness after Double-Lumen Endobronchial Tube Intubation / 대한마취과학회지

INTRODUCTION: Sore throat and hoarseness often follow general anesthesia administered via a single-lumen endotracheal tube (SLT). Numerous studies have investigated the role of factors as contributing causes, but the influence of double-lumen endobronchial tube (DLT) has not been examined systemically. The goal of this study was to examine the incidence of sore throat and hoarseness after DLT insertion. METHODS: 70 patients who were intubated with SLT or DLT were studied. Sore throat and hoarseness were evaluated after 24~48 hr from extubation of each tubes. RESULTS: In SLT and DLT group, the incidence of sore throat and hoarseness was 14 patients (40%) vs 16 patients (45.7%) and 8 patients (22.8%) vs 10 patients (28.5%), respectively. CONCLUSIONS: There are no statistical differences in incidence of sore throat and hoarseness between SLT and DLT.

Prediction of Depth of Left-sided Double Lumen Tube Insertion Using Preoperative Chest X-ray / 대한마취과학회지

INTRODUCTION: Accurate placement of double-lumen endobronchial tube (DLT) is essential for optimal gas exchange and collapse of nondependent lung during one-lung anesthesia. The goal of this study was to determine if measurement of tracheal length from the preoperative chest X-ray can be used for the prediction of adequate length of left-sided DLT insertion. METHODS: 25 patients scheduled for elective thoracotomy under one-lung anesthesia were studied. After measurement of tracheal length from preoperative chest X-ray and of length from incisor to vocal cord during intubation, the patient was intubated with left-sided DLT to the depth of predetermined length from incisor to carina. The tube position was evaluated with fiberoptic bronchocsope. RESULTS: In 22 patients (88%) the DLTs were positioned satisfactorily, and in three patients it was required to reposition DLT. CONCLUSIONS: This technique may be useful for accurate placement of DLT for the one-lung anesthesia.

Anesthetic Management of Lung Lavage in Patient with Pulmonary Alveolar Proteinosis Related to Pneumoconiosis: A case report / 대한마취과학회지

Lung lavage is an accepted modality for treatment of pulmonary alveolar proteinosis. The procedure can be accomplished by the use of double lumen endobronchial tube, with lavaging of one lung while the other is ventilated. As lung lavage is an intentional drowning, particular attention must be paid to potentially serious complications such as severe hypoxemia. We report a case of lung lavage in a patient with secondary pulmonary alveolar proteinosis performed safely by careful monitoring of oxygenation and hemodynamics.

A Study about the Bronchial Cuff Volume of the Left-sided Double-Lumen Endobronehial Tube / 대한마취과학회지

"Background: In using the Double-lumen tube (DLT), knowing the minimum bronchial cuff volume (MCV) for an effective air-tight seal will be useful; to provide a collapse of the lung; and to avoid pressure damage. The aims of the present study are thus three-fold: to measure the MCV; to measure the diameter of left main bronchus (LMBD); and to prove any relationships between two parameters. METHODS: One hundred men and forty women who needed intubation of left-sided DLT were enrolled in this study. 37 Fr DLTs were used in male patients, and 35 Fr DLTs were used in female patients. We evaluated the MCV by air bubble method and measured the LMBD in chest PA. We also evaluated the pressure/volume characteristics of the bronchial cuffs by control inflator. RESULTS: 29 patients of 100 patients (29%) exhibited persistent air leakage in 2.5 ml cuff volume in male patients (group of MCV >2.5). On the contrary, 18 patients of 40 patients (45%) did not require any cuff volume in female patients (group of MCV 0). The mean LMBD were 13.23 1.45 mm in male and 11.09 0.96 mm in female. There were significant positive correlations between MCV and LMBD in both sex and their respective correlation coefficients were 0.264 (P=0.008) in male and 0.484 (P=0.002) in female. The equations of linear regression were: LMBD = 12.394 0.429xMCV in male, LMBD = 10.725 0.438xMCV in female. CONCLUSIONS: The MCV of the brochial cuffs in left-sided DLTs has significant relationships with the LMBD measured in chest PA.