Comparative study to evaluate positioning of double-lumen endobroncheal tubes and the correlation between clinical and the role of fiber optic brochoscopy in thoracic anesthesia

ABSTRACT

Fiber optic bronchoscopy has been recommended to verify and the position of double lumen tubes [DLT], but this remains controversial. We studied the role of brochoscopy for placing and monitoring DLTs, after blind intubation and after positioning of the patient. 25 other patients undergoing thoracotomy were studied. Clinical criteria suggested good positioning in all cases, however, subsequent bronchoscopy revealed mal-position in 4 cases. A DLT was considered mal-positioned when it had to be moved> 0.5 cm to correct its position. Critical mal-position were those that might have affected patients safety or influenced the surgical procedure if left uncorrected. Bronchoscopic finding included bronchial cuff herniation and obstruction of left upper lobe brunchus. So, after blind intubation and the patient positioning, about one fifth of DLTs required repositioning. Routine fiber optic bronchoscopy is therefore recommended after intubation and after patients positioning