Abstract
Purpose
Placement of double lumen tubes (DLTs) in both normal and difficult airways may be considerably more difficult than standard laryngoscopy and intubation using standard tracheal tubes. Alternative techniques to place DLTs have not been uniformly successful and alternative tracheal tubes do not provide the versatility afforded by the DLT. We intubated the tracheas of patients undergoing thoracic procedures requiring DLTs with the Bullard laryngoscope (BL) to determine its efficacy and outline its shortcomings.
Methods
Twenty nine consecutive patients scheduled for general anesthesia requiring DLT were evaluated. The laryngeal view, time to intubation and the reason for any difficulty with intubation were recorded. Any patient who required a second DLT placement had the second attempt performed via standard laryngoscopy.
Results
The time to laryngoscopy was 9 ± 5 sec, and the time to intubation was 28 ± 10 sec. All patients had Cormack scores of grade of I through the BL. The placement of the bronchial lumen of the DLT was found to be in the correct location (left mainstem bronchus) in 9 of 28 patients.
Conclusion
The BL appears to be effective in the placing DLT into the trachea of patients.
Résumé
Objectif
Le positionnement de tube double lumière (TDL) lors d’intubation normale ou difficile peut être beaucoup plus ardu que la laryngoscopie standard et l’intubation à l’aide de tubes endotrachéaux ordinaires. Les techniques de rechange pour placer les TDL ne sont pas d’égale valeur et les tubes de remplacement ne permettent pas la polyvalence du TDL. On a procédé à l’intubation trachéale de patients qui devaient subir une chirurgie thoracique nécessitant des TDL avec le laryngoscope de Bullard (LB) pour déterminer son efficacité et en souligner les défauts.
Méthode
Vingt-neuf patients successifs devant recevoir une anesthésie générale avec TDL ont été évalués. L’aspect du larynx, le temps d’intubation et la raison de toute difficulté d’intubation possible ont été enregistrés. Chez tout patient qui a eu besoin d’un repositionnement du TDL, on a fait le second essai par laryngoscopie standard.
Résultats
Le temps de la laryngoscopie a été de 9 ± 5 s, et le temps d’intubation, de 28 ± 10 s. Tous les patients ont eu des scores de Cormack de qualité I pour le LB. La position de l’ouverture bronchique du TDL a été jugée correcte (bronche principale gauche) chez 9 des 28 patients.
Conclusion
Le LB s’est révélé efficace dans la mise en place du TDL dans la trachée.
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Shulman, G.B., Connelly, N.R. Double lumen tube placement with the Bullard laryngoscope. Can J Anesth 46, 232–234 (1999). https://doi.org/10.1007/BF03012601
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DOI: https://doi.org/10.1007/BF03012601