Determination of Accurate Double Lumen Tube Position by Fiberoptic Bronchoscopy Following Blind Intubation for Thoracic surgery

Abstract

Background: The double lumen tube (DLT) is an important element for thoracic surgery and anesthesia. With the use of fiberoptic bronchoscopy (FOB), the position of DLT in thoracic surgery can easily be observed or adjusted. However, DLT malposition occurs when patients are changed from supine to the lateral position, leading to hypoxia and lung isolation failure during one-lung ventilation (OLV). In this study the application of bronchoscopy has been observed for detecting exact position of DLTs following blind intubation and after patient positioning. Methods: A prospective study was conducted on fifty-eight patients who needed DLT insertion during thoracic surgery. 44 individuals underwent blind tracheal intubation with left-sided tubes, while 14 patients underwent it with right-sided tubes. After clinical assessment of correct placement, bronchoscopy was done in supine position and after patient positioning for thoracotomy by a different anesthesiologist. When a double lumen tube needed to be moved more than 0.6 cm to fix its position, it was deemed to be malpositioned. Extreme malposition refers to the positioning of a double lumen tube that may have jeopardized patient safety or the procedure for surgery. Results: Nine patients had clinical evidence of malposition during blind DLT intubation, which was verified by fiberoptic bronchoscopy. Correct placement of DLT by clinical assessment was found in 49 patients of which 29 cases were detected in correct position by bronchoscopy and in 20 cases malposition was detected five of which were extreme. After patient positioning for thoracotomy, in 29 patients DLTs were found to be displaced, 12 of which were extreme. Following intubation and patient positioning, right-sided DLT displacement rates were higher than left-sided DLT displacement rates for left and right sided thoracotomies. There were no instances of unsatisfactory lung collapse. Conclusions: Nearly half of the patients needed DLT repositioning after positioning for thoracotomy and more than one third after blind intubation. Fiberoptic bronchoscopy may take the role of traditional blind intubation techniques in order to determine the precise position of DLTs following intubation and patient placement for thoracic surgery.

JBSA 2023; 36 (1) : 44-48