Comparison of silicone double-lumen tube and polyvinyl chloride single-lumen tube in fiberoptic tracheal intubation on a difficult airway model: a randomized controlled non-inferiority trial.

The management of patients with history or suspicion of difficult intubation can be challenging, especially in surgical procedures requiring one-lung ventilation. The ease of insertion of silicone double lumen tube (DLT) have previously been shown to be comparable to polyvinyl single lumen tube (SLT) in fiberoptic bronchoscope (FOB) tracheal intubation. Hence, in difficult airway situation, we hypothesized that the performance of insertion of silicone DLT would also be non-inferior to polyvinyl SLT in FOB intubation. We used a neck collar to mimic patients with difficult airway. 80 patients who required one-lung ventilation were enrolled in a prospective, randomized, non-inferiority trial. Patients were randomly allocated to the DLT or SLT groups (SLT with bronchial blocker). Neck collar was supplied to all patients before FOB intubation. The time of insertion for FOB, railroading, tracheal intubation, and total procedure were measured. The difficulty of railroading was evaluated in 4 grades. In the DLT group, the railroading was significantly shorter and easier comparing to the SLT group. The total procedure was also simpler and faster in the DLT group. While simulated difficult airways may not fully replicate actual difficult airways, we suggest that fiberoptic intubation with silicone DLT could be a feasible first-line option for patients with expected difficult airways requiring lung separation, unless the size of the DLT relative to the patient's airway is problematic.Trial registration: NCT03392766.

Experimental Study of an Easily Controlled Ultra-High-Resolution Pixel-Matched Parallel-Hole Collimator with a Small Cadmium Zinc Telluride Pixelated Gamma Camera System.

The aim of this study was to develop an easily controlled, ultra-high-resolution, tungsten parallel-hole collimator based on a small pixelated gamma camera system. A small cadmium zinc telluride (CZT) pixelated semiconductor detector (eValuator-2500 detector [eV product, Saxonburg, PA]) was evaluated. This detector is composed of an array of 51.2 × 0.8 × 3-mm3 individual CZT crystal elements. The ultra-high-resolution, pixel-matched, parallel-hole collimators consisted of six layers, with the same between the hole and pixel size. The basic characteristics of the imaging system, such as sensitivity and spatial resolution, was measured using a 57Co point source. The measured averages of sensitivity and spatial resolution varied depending on the septal heights of the ultra-high-resolution parallel-hole collimator and source-to-collimator distances. When the 30-mm septal height was at 1-cm source-to-collimator distance, the spatial resolution was approximately 0.85 mm. Using 5-mm septal height, over 0.3 cps/kBq sensitivity was achieved. One advantage of our system is the use of stacked collimators that can select the best combination of system sensitivity and spatial resolution. Our results demonstrated that the developed CZT-pixelated gamma camera system using an ultra-high-resolution parallel-hole collimator of various collimator geometric designs has potential as an effective instrument.