Surgical and Radiologic Anatomy

, Volume 37, Issue 7, pp 841–844 | Cite as

Movements of the double-lumen endotracheal tube due to lateral position with head rotation and tube fixation: a Thiel-embalmed cadaver study

  • Daisuke MaruyamaEmail author
  • Tomohiro Chaki
  • Masahito Omote
  • Naoyuki Hirata
  • Masanori Yamauchi
  • Michiaki Yamakage
Original Article



Following successful double-lumen endotracheal tube (DLT) insertion for pulmonary surgery, the body position of a patient is changed from supine to lateral. This change occasionally leads to the malposition of the DLT and difficulty in differential lung ventilation.


In this study, we investigated movements of the DLT induced by change in body position from supine to lateral, using Thiel-embalmed cadavers. Thiel-embalmed cadavers retain full flexibility of the body and preservation of natural colours, using novel preservation techniques. After the tip of the DLT was directly fixed with forceps at the appropriate position in the bronchus, the DLT depth was measured at the lip in supine and lateral positions.


The depth of DLT insertion measured at the lip in right (25.2 ± 0.3 cm; mean ± SEM) and left (25.1 ± 0.3 cm) lateral positions was significantly increased compared to the supine position (24.7 ± 0.3 cm).


We recommend that the depth of DLT insertion should be advanced by approximately 0.5 cm from the best position, before changing from the supine to lateral position.


Double-lumen endotracheal tube (DLT) Thiel-embalmed cadaver Lateral position Head rotation 



The authors wish to thank Prof. Mineko Fujimiya and Dr. Daisuke Suzuki (Second Department of Anatomy, Sapporo Medical University School of Medicine) for providing cadavers and technical advice. In addition, we respect the volunteers who posthumously provided their bodies to medical research without any economic benefit.

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Benumof JL, Partridge BL, Salvatierra C, Keating J (1987) Margin of safety in positioning modern double-lumen endotracheal tubes. Anesthesiology 67:729–738CrossRefPubMedGoogle Scholar
  2. 2.
    Bessa Júnior RC, Jorge JC, Eisenberg AF, Duarte WL, Silva MS (2005) Bronchial rupture after intubation with double lumen endotracheal tube. Case report. Rev Bras Anestesiol 55:660–664CrossRefPubMedGoogle Scholar
  3. 3.
    Bregy A, Alfieri A, Demertzis S, Mordasini P, Jetzer AK, Kuhlen D, Schaffner T, Dacey R, Steiger HJ, Reinert M (2008) Automated end-to-side anastomosis to the middle cerebral artery: a feasibility study. J Neurosurg 108:567–574CrossRefPubMedGoogle Scholar
  4. 4.
    Brodsky JB, Benumof JL, Ehrenwerth J, Ozaki GT (1991) Depth of placement of left double-lumen endobronchial tubes. Anesth Analg 73:570–572CrossRefPubMedGoogle Scholar
  5. 5.
    Brodsky JB, Shulman MS, Mark JBD (1985) Malposition of left-sided double-lumen endobronchial tubes. Anesthesiology 62:667–669CrossRefPubMedGoogle Scholar
  6. 6.
    Cadière GB, Dapri G, Himpens J, Rajan A (2011) Thoracoscopic esophagectomy in prone position. Ann Surg Oncol 18:838CrossRefPubMedGoogle Scholar
  7. 7.
    Desiderio DP, Burt M, Kolker AC, Fischer ME, Reinsel R, Wilson RS (1997) The effects of endobronchial cuff inflation on double-lumen endobronchial tube movement after lateral decubitus positioning. J Cardiothorac Vasc Anesth 11:595–598CrossRefPubMedGoogle Scholar
  8. 8.
    Donn SM, Kuhns LR (1980) Mechanism of endotracheal tube movement with change of head position in the neonate. Pediatr Radiol 9:37–40CrossRefPubMedGoogle Scholar
  9. 9.
    Giger U, Fresard I, Hafliger A, Bergmann M, Krahenbuhl L (2008) Laparoscopic training on Thiel human cadavers: a model to teach advanced laparoscopic procedures. Surg Endosc 22:901–906CrossRefPubMedGoogle Scholar
  10. 10.
    Goodman LR, Conrardy PA, Laing F, Singer MM (1976) Radiographic evaluation of endotracheal tube position. AJR Am J Roentgenol 127:433–434CrossRefPubMedGoogle Scholar
  11. 11.
    Hartrey R, Kestin IG (1995) Movement of oral and nasal tracheal tubes as a result of changes in head and neck position. Anaesthesia 50:682–687CrossRefPubMedGoogle Scholar
  12. 12.
    Ikeda M, Ishida H, Tsujimoto S, Kato H (1996) Endobronchial inflammatory polyp after thoracoabdominal aneurysm surgery: a late complication of use of a double-lumen endobronchial tube. Anesthesiology 84:1234–1236CrossRefPubMedGoogle Scholar
  13. 13.
    Inoue S, Nishimine N, Kitaguchi K, Furuya H, Taniguchi S (2004) Double lumen tube location predicts tube malposition and hypoxaemia during one lung ventilation. Br J Anaesth 92:195–201CrossRefPubMedGoogle Scholar
  14. 14.
    Klein U, Karzai W, Bloos F, Wohlfarth M, Gottschall R, Fritz H, Gugel M, Seifert A (1998) Role of fiberoptic bronchoscopy in conjunction with the use of double-lumen tubes for thoracic anesthesia: a prospective study. Anesthesiology 88:346–350CrossRefPubMedGoogle Scholar
  15. 15.
    McLeod G, Eisma R, Schwab A, Corner G, Soames R, Cochran S (2010) An evaluation of Thiel-embalmed cadavers for ultrasound-based regional anaesthesia training and research. Ultrasound 18:125–129CrossRefGoogle Scholar
  16. 16.
    Pruszkowski O, Dalibon N, Moutafis M, Jugan E, Law-Koune JD, Laloë PA, Fischler M (2007) Effects of propofol vs sevoflurane on arterial oxygenation during one-lung ventilation. Br J Anaesth 98:539–544CrossRefPubMedGoogle Scholar
  17. 17.
    Riley RH, Marples IL (1992) Relocation of a double-lumen tube during patient positioning. Anesth Analg 75:1071CrossRefPubMedGoogle Scholar
  18. 18.
    Rotschild A, Chitayat D, Puterman ML, Phang MS, Ling E, Aldwin V (1991) Optimal positioning of endotracheal tubes for ventilation of preterm infants. Am J Dis Child 145:1007–1012PubMedGoogle Scholar
  19. 19.
    Saito S, Dohi S, Naito H (1985) Alteration of double-lumen endobronchial tube position by flexion and extension of the neck. Anesthesiology 62:696–697CrossRefPubMedGoogle Scholar
  20. 20.
    Seo JH, Hong DM, Lee JM, Chung EJ, Bahk JH (2012) Double-lumen tube placement with the patient in the supine position without a headrest minimizes displacement during lateral positioning. Can J Anaesth 59:437–441CrossRefPubMedGoogle Scholar
  21. 21.
    Sharma K, Varshney M, Kumar R (2009) Tracheal tube fixation: the effect on depth of insertion of midline fixation compared to the angle of the mouth. Anaesthesia 64:383–386CrossRefPubMedGoogle Scholar
  22. 22.
    Slinger PD, Campos JH (2010) Anesthesia for thoracic surgery. In: Ronald D, Miller (eds) Miller’s anesthesia 7th ed. USA. Churchill Livingstone, London, p 1835Google Scholar
  23. 23.
    Thiel W (1992) The preservation of the whole corpse with natural color. Ann Anat 174:185–195CrossRefPubMedGoogle Scholar
  24. 24.
    Weiss M, Knirsch W, Kretschmar O, Dullenkopf A, Tomaske M, Balmer C, Stutz K, Gerber AC, Berger F (2006) Tracheal tube-tip displacement in children during head-neck movement—a radiological assessment. Br J Anaesth 96:486–491CrossRefPubMedGoogle Scholar
  25. 25.
    Yoon TG, Chang HW, Ryu HG, Kwon TD, Bahk JH (2005) Use of a neck brace minimizes double-lumen tube displacement during patient positioning. Can J Anaesth 52:413–417CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag France 2014

Authors and Affiliations

  • Daisuke Maruyama
    • 1
    Email author
  • Tomohiro Chaki
    • 1
  • Masahito Omote
    • 1
  • Naoyuki Hirata
    • 1
  • Masanori Yamauchi
    • 2
  • Michiaki Yamakage
    • 1
  1. 1.Department of AnesthesiologySapporo Medical University School of MedicineSapporoJapan
  2. 2.Department of Anesthesiology and Perioperative MedicineTohoku University School of MedicineSendaiJapan

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