Canadian Journal of Anaesthesia

, Volume 39, Issue 7, pp 687–690 | Cite as

Reliability of auscultation in positioning of double-lumen endobronchial tubes

  • Bernard Alliaume
  • José Coddens
  • Thierry Deloof
Reports on Investigation

Abstract

Auscultation is a well-established technique to confirm the position of double-lumen endobronchial tubes (DLTs). However, some authors have recommended that fibreoptic bronchoscopy (FOB) is also indicated. The aims of this study were to determine first if bronchoscopy after blind placement of DLTs improved positioning; and second if preoperative bronchoscopy could detect difficult intubation. Twenty-four patients undergoing aortic or lung surgery were studied. After intubation with a single-lumen tube, an initial FOB was performed by an independent observer to check the airway anatomy. Then, the singlelumen tube was replaced by a DLT using a classical “blind” intubation method. Subsequent FOB was performed first by the independent observer to record the DLT position and next by the investigators for improvement or correction of their positioning under visual control. Fibreoptic bronchoscopy after blind placement of DLTs resulted in repositioning 78% left-sided DLTs and 83% right-sided DLTs. Preoperative bronchoscopy did not always detect an airway abnormality which might lead to difficult positioning of the DLTs. In conclusion, auscultation is an unreliable method of confirming the position of DLTs and should be followed by fibreoptic bronchoscopy.

Key words

anaesthesia: thoracic anaesthetic techniques: bronchoscopy, endobronchial equipment: tubes, endobronchial intubation: technique 

Résumé

L’auscultation pratiquée pour vérifier la position de la sonde à double lumière est une technique bien établie. Cependant plusieurs auteurs recommandent l’emploi de la fibroscopie. Les objectifs de la présente études sont les suivants: premierèment de déterminer si un contrôle fibroscopique après la mise en place de la sonde permet d’en améliorer la position; deuxièmement, si la bronchoscopie préopératoire permet d’identifier l’intubation difficile. Vingt-quatre patients programmés pour une chirurgie thoracique, aortique ou pulmonaire furent étudiés. Ils furent d’abord intubés avec une sonde endotrachéale simple pour permettre la réalisation par un observateur neutre d’une première fibroscopie dans le but d’évaluer l’anatomie des voies aériennes. Ce tube fut ensuite remplacé par une sonde à double lumière en utilisant la méthode classique d’intubation. Un nouvel examen fibroscopique permit à l’observateur neutre de vérifier le positionnement de la sonde et aux auteurs de le corriger sous contrôle visuel si nécessaire. Le contrôle fibroscopique après la mise en place de la sonde par la méthode auscultatoire a permis de repositionner 78% des tubes gauches et 83% des tubes droits. La fibroscopie préopératoire ne détecta pas toujours les anomalies des voies aériennes capables d’expliquer les erreurs de position des sondes endobronchiques. En conclusion, l’auscultation ne permet pas vérifier de façon précise la position de la sonde à double lumière et devrait suivie d’un contrôle fibroscopique.

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Copyright information

© Canadian Anesthesiologists 1992

Authors and Affiliations

  • Bernard Alliaume
    • 1
  • José Coddens
    • 1
  • Thierry Deloof
    • 1
  1. 1.Department of Anaesthesia and Intensive CareOnze-Lieve-Vrouw ZiekenhuisAalstBelgium

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