纤维支气管镜用于双腔支气管导管的定位

目的 研究纤维支气管镜（FOB）在国人双腔支气管导管插管定位中的应用。方法 90例行择期开胸手术、术中需要单肺通气的病人，ASAⅠ-Ⅱ级。全麻诱导后用传统方法插入双腔支气管导管。听诊法确定和调整导管的位置，然后用FOB确定和调整导管的位置。在病人由平卧位变为侧卧位后再次为FOB确定和调整导管的位置。记录各次导管的深度。结果 FOB检查发现盲法置入的68%左侧和62%右侧双腔导管位置不正确，导管过深的情况更多见；导管在最佳位置时的深度与病人的身高无相关性；24%病人侧卧位后导管位置有变动，以向近侧移动居多。结论 在初始插管及体位变动后，用纤维支气管镜确定和调整双腔导管的位置更准确、可靠、应常规使用。     

Fibreoptic bronchoscopy for tracheal and endobronchial intubation with a double-lumen tube

A 68-year-old patient was scheduled for a thoracotomy. A double-lumen endobronchial tube was requested by the surgeon to facilitate operating conditions. Initial attempts at intubation by conventional methods were unsuccessful. The proximal ends of a 37F double-lumen tube were then shortened and a 4-mm fibreoptic bronchoscope was passed through the bronchial lumen. The patient's larynx was easily visualized and the bronchoscope was passed into the trachea. The double lumen tube was then advanced over the bronchoscope and correctly positioned. Shortening a double-lumen tube allows the use of a fibreoptic bronchoscope to aid in tracheal intubation in a patient whose larynx is difficult to visualize by conventional methods.     

A clinical evaluation of the modified right-sided double-lumen endobronchial tube

Journal of Anesthesia -     

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

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.     

Usability of modified INTLOCK for double-lumen endobronchial tube insertion with airway scope

BACKGROUND: An AirWay Scope (AWS, PENTAX Corporation, Tokyo, Japan) is a video-laryngoscope with a built-in LCD monitor used for tracheal intubation, while INTLOCK (PENTAX Corporation) is a specialized laryngoscope blade that encases the tip of AWS. The characteristic shape of INTLOCK fits the oropharyngeal anatomy and enables even less experienced operators to obtain an optimal view during tracheal intubation procedures, although it is limited to tracheal tubes of less than 11.5 mm outer diameter. Therefore, AWS is not suitable for double-lumen endobronchial tube (DLT) insertion. To resolve this issue, we developed modified INTLOCK for DLT insertion in cooperation with PENTAX, in which a portion of the tube guide was removed. METHODS: Following institutional review board approval and written informed consent from the subjects, we prospectively enrolled 10 patients scheduled for thoracic procedures requiring DLT and investigated the usability of modified INTLOCK. RESULTS: All subjects were successfully intubated with modified INTLOCK, with only minor complications (mild hemorrhage, sore throat and hoarseness) occurring in 5 cases. CONCLUSIONS: We were able to insert DLT in all subjects using modified INTLOCK without serious complications. The results indicate the usability of the device.     

Rupture of the left main-stem bronchus by the tracheal portion of a double-lumen endobronchial tube

We report a rupture of the left main-stem bronchus following the insertion of a left-sided double-lumen endobronchial tube in a 76-yr-old woman with a short trachea. A fiberoptic bronchoscope was not used during the initial insertion of the tube and the depth of insertion resulted in approximately 5 cm in excess of the optimal level for this patient. The rupture had been caused by the tracheal portion of the double-lumen tube. This damage may have been avoided if a fiberoptic bronchoscope was used routinely as an introducer and for positioning of the endobronchial tube under direct vision.     

Difficult ventilation with a double-lumen endotracheal tube: an unusual manufacturing defect

We report an unexpected difficult ventilation with a double-lumen endotracheal tube in a patient receiving left upper lobe lung mass resection. The manufacturing defect in both limbs of the Opti-Port Right Angle Double Swivel Connector of the double-lumen tube resulted in this problem. This defect is difficult to localize by the usual recommended methods. We discuss a modified algorithm for difficult ventilation with a double-lumen endotracheal tube. IMPLICATIONS: Difficult ventilation occurred during general anesthesia as the result of a manufacturing defect in both limbs of the connector of the double-lumen endotracheal tube. The problem was resolved with a careful approach, and there were no serious consequences.     

Use of a video fiberoptic bronchoscope to assist double-lumen endobronchial tube intubation in a patient with a difficult airway

In clinical scenarios, the insertion of double-lumen endobronchial tubes (DLTs) is usually employed as a technique of separation of lungs for treatment purposes inclusive of one-lung ventilation for the ease of thoracic surgery. However, in patients with difficult airways, the DLT intubation can be challenging, even with the aid of a fiberoptic bronchoscope (FOB). Insertion of the FOB itself into the trachea may be relatively simple, but the advancement of the DLT with the FOB enclosed in the lumen may be hindered by the abnormal or diseased laryngeal aperture. Herein, we present an alternative approach by using a 5.5-mm video FOB to monitor the DLT rather than using it to act as an introducer to overcome the difficulties often met in DLT intubation in oral cancer patients.     

The diagnostic challenge of a tracheal tear with a double-lumen endobronchial tube: massive air leak developing from the mouth during mechanical ventilation

The case of a 78 year-old woman who underwent a right lower lobectomy using a 35-French, left-sided, double-lumen endobronchial tube (DLET) is presented. Multiple adjustments were needed for the DLET's proper placement. At the end of surgery, sudden loss of tidal volume with a large air leak from the patient's mouth was noted. Fiberoptic bronchoscopic examination through the DLET was negative. Rupture of the tracheal cuff was suspected, and the DLET was replaced with a single-lumen tube. In the intensive care unit, the massive air leak from the mouth recurred during mechanical ventilation. Nasal fiberoptic bronchoscopic examination showed a longitudinal laceration of the membranous portion of the trachea extending from the subglottic area to the orifice of the right bronchus. Surgical repair of the tear was performed.