Canadian Journal of Anaesthesia

, Volume 43, Issue 3, pp 238–242

Placement of left double-lumen endobronchial tubes with or without a stylet

  • Dianne Lieberman
  • Judith Littleford
  • Tom Horan
  • Helmut Unruh
Reports of Investigation

Abstract

Purpose

This study was designed to determine if leaving a stylet in the left Bronch-Cath® endobronchial tube (DLT) for the entire intubating procedure improves the accuracy of placement on the initial attempt, without introducing complications.

Methods

Sixty ASA 1–3 patients were randomized to one of two groups. In Group 1 (n − 30), the stylet was retained for the entire intubation procedure and in Group 2 (n = 30), the stylet was removed once the bronchial cuff had passed the vocal cords. In both groups, the DLT was turned 110° counterclockwise and advanced until resistance was encountered. Placement was assessed by auscultation and fibreoptic bronchoscopy (FOB). After surgery, the DLT was replaced by a single-lumen endotracheal tube. The thoracic surgeon (blinded to the method of intubation, and using a FOB) assessed the appearance of the tracheobronchial mucosa.

Results

The two groups were similar with respect to sex, height, weight, DLT size, surgeon and expertise of the laryngoscopist. When the stylet was retained, the DLT was correctly placed 60% of the time compared with 17%, if the stylet was removed, (P = 0.001). Seven out of 30 DLTs in Group 2 were initially placed into the right mainstem bronchus, (P = 0.005). The average time to confirmation of correct tube placement by FOB was increased in Group 2, (P = 0.01). Although the observed incidence of left bronchial, mucosal petechiae and erythema was greater in Group 2, this was not statistically significant, (P = 0.063).

Conclusion

Retaining the stylet for the entire intubation procedure allows for a more rapid, accurate placement of the DLT without increasing the incidence of tracheobronchial mucosa injury.

Key words

anaesthesia: thoracic anaesthetic techniques: bronchoscopy, endobronchial, one-lung anaesthesia equipment: double-lumen endobronchial tubes intubation: technique 

Résumé

Objectif

Cette étude visait à déterminer si le fait de laisser un guide dans un Bronch-Cath® endobronchique gauche (TEG) pendant toute la manoeuvre d’intubation assurait l’exactitude de la position dès la première tentative et ne provoquait pas de complications.

Méthode

Soixante patients ASA 1—3 ont été répartis aléatoirement en deux groupes. Dans le groupe 1 (n = 30), le guide est demeuré en place pendant la manoeuvre d’intubation, et dans le groupe 2, le guide a été enlevé dès que le tube êut passé les cordes vocales. Dans les deux groupes, le TEG a été pivoté à 110° dans le sens contraire aux aiguilles d’une montre et avancé jusqu’à la rencontre d’une résistance. La position du tube a été vérifiée par auscultation et bronchofibroscopie. Après la chirurgie, le TEG a été remplacé par une tube ordinaire. Le chirurgien thoracique (qui ignorait la méthode d’intubation et utilisait un bronchofibroscope) a évalué la muqueuse trachéobronchique selon son apparence.

Résultats

Les deux groupes étaient identiques quant au sexe, la taille, le poids, le diamètre du tube, le chirurgien et la compétence du laryngoscopiste. Avec un guide en place, le TEG a été correctement installé 60% du temps comparativement à 17% avec retrait du guide (P = 0,001). Dans le groupe 2, dans sept cas sur 30, le TEG a été placé initialement dans la bronche souche gauche (P = 0,005). Le délai de confirmation de l’exactitude de la position vérifiée par bronchofibroscope a été prolongé dans le groupe 2 (P = 0,01). L’incidence d’érythème et de pétéchies de la muqueuse bronchique, bien que plus élevée dans le groupe 2, n’était pas significative (P = 0,063).

Conclusion

Le maintien du guide pendant la manoeuvre d’intubation du TEG permet une mise en position rapide et précise sans augmentation de l’incidence de lésions muqueuses trachéobronchiques.

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Copyright information

© Canadian Anesthesiologists 1996

Authors and Affiliations

  • Dianne Lieberman
    • 1
  • Judith Littleford
    • 1
  • Tom Horan
    • 1
  • Helmut Unruh
    • 1
  1. 1.Department of Anaesthesia and Section of C.V.T. SurgeryUniversity of Manitoba, Health Sciences CentreWinnipeg
  2. 2.Department of AnaesthesiaHealth Sciences CentreWinnipegCanada

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