Choosing the Correct?Sized Adult Double?Lumen Tube: Quest for the Holy Grail

Appropriate size selection of double?lumen tubes (DLTs) for one?lung ventilation (OLV) in adults is still a humongous task. Several important factors are to be considered like patient height, gender, tracheal diameter, left main bronchial diameter, and cricoid cartilage transverse diameter. In addition to radiological assessment of the airway diameters, the manufacturing details of the particular DLT being used also play a significant role in size selection. Optimal positioning of the appropriately sized DLT is indispensable to avoid complications like airway trauma, cuff rupture, hypoxemia, and tube displacement. It is imperative to know whether the one?size?fits?all dictum holds for DLT size selection as claimed by certain studies. Further randomized studies are required for crystallizing standard protocols ascertaining the correct DLT size. This systematic review article highlights the various parameters employed for DLT size selection and explores the newer DLTs used for adult OLV.

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.

Intubation with Vivasight Double?Lumen Tube Versus Conventional Double?Lumen Tube in Adult Patients Undergoing Lung Resection: A Retrospective Analysis

Objectives: The present study was designed to compare outcomes in patients undergoing thoracic surgery using the VivaSight double?lumen tube (VDLT) or the conventional double?lumen tube (cDLT). Design: A retrospective analysis of 100 patients scheduled for lung resection recruited over 21 consecutivemonths (January 2018–September 2019). Setting: Single?center university teaching hospital investigation. Participants: A randomized sample of 100 patients who underwent lung resection during this period were selected for the purpose to compare 50 patients in the VDLT group and 50 in the cDLT group. Interventions: After institutional review board approval, patients were chosen according to inclusion and exclusion criteria and we created a general database.The 100 patients have been chosen through a random process with the Microsoft Excel program (Microsoft 2018, Version 16.16.16). Measurements and Main Results: The primary endpoint of the study was to analyze the need to use fiberoptic bronchoscopy to confirm the correct positioning of VDLT or the cDLT used for lung isolation. Secondary endpoints were respiratory parameters, admission to the intensive care unit, length of hospitalization, postoperative complications, readmission, and 30?day mortality rate. The use of fiberoptic bronchoscopy was lower in the VDLT group, and the size of the tube was smaller.The intraoperative respiratory and hemodynamics parameters were optimal. There were no other preoperative, intraoperative, or postoperative differences between both groups. Conclusions: TheVDLT reduces the need for fiberoptic bronchoscopy, and it seems that a smaller size is needed.Finally,VDLT is cost?effective using disposable fiberscopes.

Comparison between computerized tomography-guided bronchial width measurement versus conventional method for selection of adequate double lumen tube size

Background: Selection of adequate size double lumen tube (DLT) is complicated by marked inter-individual variability in morphology and dimensions of tracheobronchial tree. Computerized tomography (CT)-guided left bronchus width measurement has been used to predict adequate size DLT in European and Singapore population; however, no such data exist for Indian population who are racially different. We compared the effect of DLT size selection based on CT-guided bronchial width measurement to the conventional method of DLT selection on the adequacy of both lungs isolation and on the safety margin of right-sided DLT. Methods: Fifty-five adults scheduled to undergo thoracotomy were enrolled in this prospective observational study. An appropriate size left- or right-sided DLT with outer diameter 0.5–1 mm smaller than the CT-measured bronchial width was selected for the isolation of lungs. Adequacy of separation was checked using fiberoptic bronchoscope. The safety margin of selected right-sided DLT size was calculated from CT-measured right upper lobe bronchus width and diameter of right upper lobe ventilation slot of the DLT. Results: Adequate separation of lungs was achieved in 92.7% of studied population, 90.9% in males, and 95.4% in females. Among these, 54.9% patients required different sized DLT as compared to conventional method. Overall safety of margin of right-sided DLTs was comparable between two methods of DLT selection (median [IQR] 4.8 (3.5–6.8) vs. 6.59 (3.5–7.8), P = 0.317). DLT size with adequate isolation of lung correlated with height, tracheal width (TW) on chest X-ray, and age of the patients. A formula to calculate DLT size based on these variable was derived. Conclusion: CT-measured bronchial width predicts the appropriate DLT size better than conventional method. In the absence of CT scan facility, patient height, age, and chest X-ray TW may be used to predict DLT size with reasonable accuracy.

Practice patterns of left-sided double-lumen tube: Does it match recommendation from literature – A single-centre observational pilot study

Context: Choosing appropriate-size double-lumen tube (DLT) has always been a challenge as it depends on existing guidelines based on gender, height, tracheal diameter (TD), or personal experience. However, there are no Indian data to match these recommendations. Aim: To find out whether the size of DLT used correlates with height, weight, TD, or left main stem bronchus diameter (LMBD). We also documented clinical consequences of any of our current practice. Setting and Design: Single-center observational pilot study. Subjects and Methods: Prospective, observational study of 41 patients requiring one-lung ventilation with left-side DLT. The choice of DLT was entirely on the discretion of anesthesiologist in charge of the case. Data were collected for TD, LMBD, height, weight, age, sex, and amount of air used in the tracheal and bronchial cuff. Any intraoperative complications and difficulty in isolation were also noted. Statistical Analysis: The statistical analysis was done with the National Council of Statistical Software version 11. Results: Average TD and LMBD were 16.5 ± 0.9 and 10.7 ± 0.8 mm for males and 14.2 ± 1.1 and 9.4 ± 1.1 mm for females, respectively. There was a weak correlation between DLT size and height (R2 = 0.0694), TD (R2 = 0.3396), and LMBD (R2 = 0.2382) in the case of males. For females, the correlation between DLT size and height (R2 = 0.2656), TD (R2 = 0.5302), and LMBD (R2 = 0.5003) was slightly better. Conclusion: Although there was a weak correlation between DLT size and height, TD, and LMBD, the overall intraoperative outcome and lung isolation were good.

Correlation between the Depth of the Left-Sided Double-Lumen Tube and Specific Body Landmarks / 中国医科大学学报

Objective To investigate the correlation between the insertion depth of the left-sided double-lumen tube (DLT) and some specific body landmarks in order to guide left-sided DLT intubation. Methods Ninety-five adult patients who underwent thoracic surgery were chosen, and the age (A), sex (S), height (H), weight (W), distance between the cricothyroid membrane and upper notch of the sternum angle (L), size of the left-sided DLT (F), and predicted depth of intubation (y) were recorded. After anesthesia induction, the final corrected insertion depth of the left-sided DLT (Y) were recorded using fiberoptic bronchoscopy. The Y and y were compared.Linear regression and Pearson's correlation analysis were used to analyze the data. Results There was no difference between the Y and y (P＞ 0.05). The Y was significantly correlated with H, W, and L (P ＜ 0.01), and was not correlated with A (P＞ 0.05). Three linear regression equations for H, L, and Y were obtained. H and L were linearly dependent on Y, and the determination coefficients R2 were 0.43 (Y=7.285+0.128 H) and 0.41 (Y=19.305+0.866 L), respectively. Using both H and L as the independent variables, the determination coefficient R2 was 0.56 (Y=8.127+0.087 H+0.559 L). Conclusion The linear regression equation Y=8.127+0.559 H+0.087 L could be used as a rapid method to assess the insertion depth of the left-sided DLT. However, the ideal insertion depth of the left-sided DLT still needs to be confirmed using fiberoptic bronchoscopy.

A prospective randomized controlled double-blind study comparing auscultation and lung ultrasonography in the assessment of double lumen tube position in elective thoracic surgeries involving one lung ventilation at a tertiary care cancer institute / 대한마취과학회지

BACKGROUND: As lung ultrasound (LUS) can be used to identify regional lung ventilation and collapse, we hypothesize that LUS can be better than auscultation in assessing lung isolation and determining double lumen tube (DLT) position. METHODS: A randomized controlled study was conducted in tertiary care cancer institute from November 2014 to December 2015, including 100 adult patients undergoing elective thoracic surgeries. Patients with tracheostomy, difficult airway and pleural-based pathologies were excluded. After anesthesia induction and DLT insertion, patients were randomized into group A (auscultation) and group B (LUS). Regional ventilation was assessed by experienced anesthesiologists using the respective method for each group. Final confirmation of DLT position with a bronchoscope was performed by a blinded anesthesiologist. Contingency tables were plotted to determine sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy for each method. RESULTS: Data from 91 patients were analyzed (group A = 47, group B = 44). Compared with auscultation, LUS had significantly higher sensitivity (94.1% vs. 73.3%, P = 0.010), PPV (57.1% vs. 35.5%, P = 0.044), NPV (93.8% vs. 75.0%, P = 0.018), accuracy (70.5% vs. 48.9%, P = 0.036) and required longer median time (161.5 vs. 114 s, P < 0.001) for assessment of DLT position. Differences in specificity (55.6% vs. 37.5%, P = 0.101) and area under curve (0.748; 95% CI: 0.604–0.893 vs. 0.554, 95% CI: 0.379–0.730; P = 0.109) were not significant. CONCLUSIONS: Compared to auscultation, LUS is a superior method for assessing lung isolation and determining DLT position.

Valoracion del bloqueo pulmonar mediante ecografia en cirugia de tórax. primera experiencia en nuestro medio / Assessment of pulmonary blocking through ecography in torax surgery. first experience in our environment

Objetivo: evaluar validez y eficacia de la ecografía pulmonar frente al método clínico para corroborar intubación selectiva izquierda en cirugía de tórax. Material y Método: estudio transversal, observacional, prospectivo, doble ciego. Se incluyeron en forma consecutiva 59 pacientes en 2 etapas: (etapa 1- n 15 puesta a punto de la técnica; etapa 2- n 44) . Luego de la intubación con un tubo doble luz izquierdo, pinzamiento secuencial de ambas luces, evaluación de posición clínicamente y por ecografía con confirmación posterior por fibrobroncoscopia (gold estándar) . Resultados etapa 2: 56,8% (n=25) de los casos el tubo estaba bien colocado. Validez de la ecografía (correcta colocación): sensibilidad de 84,00% (IC 95%: 63,08-94,75), especificidad de 94,74% (IC 95%: 71,89-99,72), Valor predictivos positivo 95,45% (IC 95%: 75,12-99,76), Valor predictivo negativo de 81,82% ((IC al 95%: 58,99-94,01). Validez de la auscultación pulmonar: sensibilidad de 96,00% (IC al 95%: 77,68-99,79), especificidad de 100.00% (IC al 95%: 79,08-100.00), valor predictivos positivo de 100.00% (IC al 95%: 82,83-100.00) , Valor predictivo negativo de 95.00% ((IC al 95%: 73,06-99,74). Discusión: las diferencias de resultados con otros autores podrían responder a diferencias en la experticia (primera experiencia en nuestro medio), criterios de inclusión más amplios, número de pacientes. Se propone aumentar el tamaño de la muestra ''n '' e incorporar otros signos ecográficos de evaluación. Conclusión: la ecografía se presenta en forma prometedora como una herramienta complementaria a la evaluación clínica.

Goal: assessing the validity and effectiveness of pulmonary ultrasound against clinical method to corroborate left selective intubation on thorax surgery. Material and method: transversal study, observational, prospective, double blind. 59 patients in 2 different stages where included: (1-n 15 technique development; 2-n 44). After intubation with left double-lumen tube, sequential clamping of both lights, both clinically assessment of position and through ultrasound with subsequent confirmation through fibrobronchoscopy (reference standards). Stage 2 results: In 56.8% (n=25) of cases the tube was placed properly. Ultrasound validation (proper collocation): sensitivity of 84,00% (IC 95%:63.08-94.75), specificity of 94.74% (IC 95%: 71.89-99.72), Positive predictive values 95,45% (IC 95%: 75.12-99.76), Negative predictive value 81,82% ((IC at 95%: 58.99-94.01). Validity of pulmonary auscultation: sensitivity of 96.00% (IC at 95%: 77.68-99.79), Specificity of 100.00% (IC at 95%: 79.08-100.00), positive predictive values of 100.00% (IC at 95%: 82.83-100.00), Negative predictive value of 95.00% ((IC at 95%: 73.06-99.74). Discussion: the difference in results with other authors might respond to difference in expertise (first experience on our medium), wider inclusion criteria, and number of patients. We propose increasing the "n" and adding other ultrasonic signs of assessment. Conclusion: ultrasound is presented in a promising way as a complementary tool to clinic evaluation.

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.

Management of pulmonary alveolar proteinosis with whole lung lavage using extracorporeal membrane oxygenation support in a postrenal transplant patient with graft failure.

Pulmonary alveolar proteinosis (PAP) is a rare lung disease characterized by accumulation of excessive lung surfactant in the alveoli leading to restrictive lung functions and impaired gas exchange. Whole lung lavage (WLL) is the treatment modality of choice, which is usually performed using double lumen endobronchial tube insertion under general anesthesia and alternating unilateral lung ventilation and washing with normal saline. It may be difficult to perform WLL in patients with severe hypoxemia wherein patients do not tolerate single lung ventilation. Extracorporeal membrane oxygenation support (ECMO) has been used in such patients. We report a patient with autoimmune PAP following renal transplant who presented with marked hypoxemia and was managed by WLL under ECMO support.

Effect comparison of two lumen tubes in simple negative pressure drainage / 中国基层医药

Objective To investigate the effect of double lumen tube applied in the simple negative pressure drainage.Methods Forty cases were divided into two groups by a random table method,with 20 cases in each group. The double lumen tube was used in observation group while the normal gastric tube was used in control group,then the indexes on the drainage effect and wound healing were quantized and analyzed.Results In the observation group,one case suffered obstruction at 2 -4 days,1 case after 4 days of treatment,the obstruction rate was 10%.In the control group,two cases suffered obstruction at 2 -4 days,and 2 cases after 4 days of treatment,the obstruction rate was 25%.There was significant difference between two groups(χ2 =9.212,5.021,P =0.027,0.032).There were two cases of delayed healing and 17 cases with effective in the observation group,but 8 cases delayed healing and 11 cases with effective in the control group,there was statistically significant difference (χ2 =5.833,4.800,P =0.016, 0.028).Conclusion Double lumen tube can delay the occurrence time and reduce the occurrence rate of obstruction in simple negative pressure drainage,which promotes wound healing,and it is worth popularizing and using clinically.

Comparison of McGrath-5 video-laryngoscope and McCoy laryngoscope guided double-lumen tube intubation in patients with difficult airway / 中国内镜杂志

Objective To compare the clinical efficacy of double-lumen tube intubation between McGrath-5 video-laryngoscope and McCoy laryngoscope in patients with difficult airway. Methods Sixty patients who were predicted as difficult double-lumen tube intubation were divided into two groups using random number table method:McGrath-5 video-laryngoscope group (group A, n = 30) and McCoy laryngoscope group (group B, n = 30). All patients were intubated by two laryngoscopes correspondingly after conventional induction. The success rate of the first intubation, intubation time, the ratio of right positioning, the number of SpO2 < 90% within intubation time, the number of pressing the cricoid, the incidence of intubation complications and hemodynamic parameters [The changes in systolic pressure and heart rate and BIS were recorded before induction (T0), glottic exposure upon laryngoscope insertion (T1), immediately after intubation (T2), 3 min (T3) after intubation]. Results The number of pressing the cricoid was smaller in group A than in group B (P < 0.05), whereas the intubation time in group A was significantly higher than that in group B (P < 0.05). The systolic pressure and heart rate at T3 were dramatically reduced compared with those measured at T0 in both groups (P < 0.05). The systolic pressure and heart rate at T1 and T2 in group A were considerably lower in group A than those in group B (P < 0.05). Conclusions Compared with the McCoy laryngoscope, double-lumen tube intubation by McGrath-5 video-laryngoscope can less impact on hemodynamics, less intubation complications, intubation time although prolonged but not for influence the patient's oxygen supply, for difficult airway double-lumen tube intubation provides a good choice.

A comparison of the double lumen tube with the single lumen tube in the application of minimally invasive esophagectomy / 中华胸心血管外科杂志

Objective To compare the pulmonary complications between the double lumen tube and the single lumen tube,and to determine whether there are objective advantages of one over the other in one-lung ventilation during minimally invasive esophagectomy(MIE).Methods From January 2012 to November 2013,165 patients with esophageal cancer received combined thoracoscopic and laparoscopic esophagectomy with anastomosis in the neck.All clinical data were retrospectively reviewed.Results Between the single lumen tube and the double lumen tube:patients with pulmonary infection is 11 (16.42％),34(34.69％) (P =0.010).The average intubation time is(1.45 ±0.22)min,(6.53 ±0.59) min,P =0.000.The number of harvested lymph nodes of total is (42.76 ± 18.11) and (34.32 ± 15.80),P =0.002.The number of harvested lymph nodes of the cervix and the left laryngeal recurrent nerve chain was (3.19 ± 2.53) and (1.30 ± 2.14),P =0.000.Conclusion In the minimally invasive esophagectomy,single lumen tube is simpler and easier than the double lumen tube,and with the low incidence of postoperative pulmonary complications,at the same time there are more advantageous in the meditational lymph nodes cleaning.

The correlation between the BMI and the length and diameter of the main bronchi on three-dimensional images in adults / 实用放射学杂志

Objective To measure the length and diameter of the main bronchus using three-dimensional reconstruction from spi-ral chest computerized tomography scans in Chinese patients,and to evaluate the relationship between the BMI of patients and the length and diameter of main bronchi in order to provide the basis for pre-operative tracheal intubation.Methods 100 males and 100 females,who were scheduled to undergo a chest CT scan for physical examination,the diameter at the carina of the left and right main bronchus were measured.The length of the main bronchi extending from the carina to the line that is vertical to the bronchial wall at the starting point from the branches of the upper lobe was measured at the workstation.Results the length of the men’s right and left main bronchus was (1 9.7±5.2)mm and (50.3 ±4.7)mm.the length of the women’s right and left main bronchus was (18.2±4.1)mm and (46.3±4.5)mm,The length of the left main bronchus(LMB)was about 3-4 times greater than right main bronchus(RMB).the cross-section of the men’s left and right main bronchus was (175.3±29.6)mm2 and (209.4±32.7)mm2 ,the cross-section of the women’s left and right main bronchus was (120.5±24.8)mm2 and (144.4±33.7)mm2 .There was no signifi-cant relationship between the length and diameter of main bronchi and the BMI of patients.Conclusion The results showed that there was no direct relationship between the diameter and the length of main bronchi and the BMI of patients.BMI is not the criteri-on for choosing double-lumen tube (DLT)size.We proposed that three-dimensional reconstruction be used to measure the size of the main bronchi and determine the optimal size of the DLT in a clinical setting.

ONE LUNG ANAESSTHESIS DURING THE THORACIC SURGERY / Шинэ санаа Шинэ нээлт

Thoracic surgery usually used for anesthesia double lumen endotracheal tubes, then ventilated one lung in NCC of Mongolia The clinical records of the 160 cases patients who had double-lumen endotracheal tubes to place in NCC of Mongolia. In patients during one lung anesthesia done 2012- 2014 were reviewed. All cases were performed high level thoracic epidural catheterization and put double lumen tube for jugular internal vena We are reporting 2012- 2014 anesthesia department at National Cancer Center of Mongolia. In our study involved all 160 open thoracic surgery cases with DLT. In study had anesthesia tidal volume 7.77+1.07ml/kg, one lung volume5.87+0.46 ml/kg, the Mongolian women DLT size 35.43+2.25Fr, deep 27.68+2.47 cm, Mongolian man DLT size 37.09+4.69cm, deep 28.43+2.6 cm. During anesthesia monitored average SpO2-95%+ 1.07,in analyzed arterial blood average SaO2- 92.65 %+ 5.69. (p<0.032) One lung anesthesia separating two lungs by double lumen tube (DLT) – the advantages of the method are allowing surgeons to operate safely in collapsed side of lung; there are a few reports of airway damages. The bronchoscope procedure is in need to use during the all operations in Mongolia. Other types of separation tube are required to be (especially in children) introduced. In the future lungs, esophagus, mediastinal tumors and heart, spine and vascular surgery need double lumen tube to global standards anesthesia widely available in Mongolia. The thoracic anesthesia use double lumen tube outside the epidural anesthesia decided that it can be combined with postoperative pain control. Correct technique of placing the double lumen tube one lung anesthesia surgical team and the shortness of time and the surgical risk patients with post-surgical complications and reduce mortality is of high importance in Mongolia. In our study is a dominant decided that it was linked to smoking habits

Effect of lidocaine aerosol on cardiovascular response and postoperative sore throat, hoarseness in patients receiving double lumen tube intubation / 第二军医大学学报

Objective: To observe the effect of lidocaine aerosol on preventing cardiovascular response and sore throat, hoarseness in the patients with double lumen tube to orotracheal intubation. Methods: 60 selective patients (ASA I - II) scheduled for lung lobectomy were randomly divided into 3 groups, with 20 cases in each group. Lidocaine aerosol (group A) and Saline as a control (group B and group C) were given to spray. After routine induction, the glottis was exposed and 3 press lidocaine aerosol were given in group A, while group B and C were given saline. Patients in group C were received additional 0.5mg/kg of propofol and 1μg /kg of fentanyl intravenously before the exposure of glottis. HR, SBP, DBP, HR*SBP were monitored and recorded at the time points of pre-induction (T0), immediately pre-intubation (T1), 1 min (T2), 3 min (T3), 5min (T4), 10min (T5) after intubation. Cases of sore throat and hoarseness were also recorded at the point of 1h, 6h, 24h postoperation. Results: Compared with T0, values of HR, SBP and RPP at T1 were significantly decreased after inductionP<0.05. Values of HR, SBP, RPP in group B and C were higher than that in group A at T2 and T3P<0.05. SBP was significantly decreased at T4 and T5 in group CP<0.05. Cases of postoperative sore throat and hoarseness in group A were significantly lower than that in group B and CP<0.05. Conclusion: Lidocaine aerosol can effectively suppress cardiovascular responses caused by double lumen tube intubation, decrease the dose of induction drugs, reduce the incidence of postoperative sore throat and hoarseness.

Outcome of one lung ventilation thoracic surgery / Монголын Анагаах Ухаан

Goal: Thoracic surgery usually used for anesthesia double lumen endotracheal tubes, then ventilatedone lung.Methods: The clinical records of the 160 cases patients who had double-lumen endotracheal tubes toplace in National Cancer Center of Mongolia (this structure starts from the inferior part of the larynxin the neck, opposite the 6th cervical vertebra, to the intervertebral disc between Th4-5 vertebrae inthe thorax, where it divides at the carina into the right and left bronchi). Inpatients during one lunganesthesia done 2012- and 2014 were reviewed. All cases were performed high Level thoracic epiduralcatheterization and put double lumen tube for jugularinternal vena. Double-lumen endotracheal tubesare not meant for postoperative ventilation. In addition, because of their significantly larger size andstiffness, they have a higher propensity for trauma after insertion, which may result in postoperativehoarseness or vocal cord lesions.Results: We are reporting 2012- 2014 anesthesia department at National Cancer Center. In our studyinvolved all 160 open thoracic surgery cases with DLT. In study had anesthesia tidal volume7.77+1.07ml/kg, one lung volume 5.87+0.46 ml/kg, the women DLT size 33.43+7.25Fr, deep 27.68+2.47 cm, manDLT size 37.09+7.69cm, deep 28.43+2.6 cm. During anesthesia monitored averageSaO2-95%+1.07,in analyzed arterial blood average SpO2- 92.605 %+5.69 (p<0.032).Conclusion: One lung anesthesia separating two lungs by double lumen tube (DLT) – the advantagesof the method are allowing surgeons to operate safely in collapsed side of lung; there are a few reportsof airway damages. The bronchoscopy procedure is in need to use during the alloperations. Other typesof separation tube are required to be (especially in children) introduced.

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.

Successful double lumen tube insertion in a patient with unanticipated laryngeal and tracheal web.

A 45-year-old female patient admitted for surgical management of carcinoma esophagus, presented with difficulty in insertion of left-sided 37 F and 35 F double lumen tube (Mallinckrodt® Broncho-Cath). Fiberoptic bronchoscopy revealed a subglottic web in the larynx just below the vocal cords and a tracheal web just above the carina. Differential lung ventilation could be achieved with a 35 F internal diameter double lumen tube (Portex® Blueline® Endobronchial tube).