A randomized trial to assess the utility of preintubation adult fiberoptic bronchoscope assessment in patients for thoracic surgery requiring one‑lung ventilation.
Loading...
Date
2016-04
Journal Title
Journal ISSN
Volume Title
Publisher
Abstract
Background: Confirmation of placement of Double lumen endobronchial tubes (DLETT) and bronchial
blockers (BBs) with the pediatric fiberoptic bronchoscope (FOB) is the most preferred practice worldwide.
Most centers possess standard adult FOBs, some, particularly in developing countries might not have
access to the pediatric‑sized devices. We have evaluated the role of preintubation airway assessment
using the former, measuring the distance from the incisors to the carina and from carina to the left and right
upper lobe bronchus in deciding the depth of insertion of the lung isolation device. Methods: The study
was a randomized, controlled, double‑blind trial consisting of 84 patients (all >18 years) undergoing thoracic
surgery over a 12‑month period. In the study group (n = 38), measurements obtained during FOB with the
adult bronchoscope decided the depth of insertion of the lung isolation device. In the control group (n = 46),
DLETTs and BBs were placed blindly followed by clinical confirmation by auscultation. Selection of the type
and size of the lung isolation device was at the discretion of the anesthesiologist conducting the case. In all
cases, pediatric FOB was used to confirm accurate placement of devices. Results: Of 84 patients (DLETT
used in 76 patients; BB used in 8 patients), preintubation airway measurements significantly improved the
success rate of optimal placement of lung isolation device from 25% (11/44) to 50% (18/36) (P = 0.04).
Our incidence of failed device placement at initial insertion was 4.7% (4/84). Incidence of malposition was
10% (8/80) with 4 cases in each group. The incidence of suboptimal placement was lower in the study group
at 38.9% (14/36) versus 65.9% (29/44). Conclusions: Preintubation airway measurements with the adult
FOB reduces airway manipulations and improves the success rate of optimal placement of DLETT and BB.
Description
Keywords
Airway assessment, Bronchial blocker, Double‑lumen tubes, Fiberoptic bronchoscope, One‑lung ventilation, Thoracic surgery
Citation
Amin Nayana, Tarwade Pritee, Shetmahajan Madhavi, Pramesh C S, Jiwnani Sabita, Mahajan Abhishek, Purandare Nilendu. A randomized trial to assess the utility of preintubation adult fiberoptic bronchoscope assessment in patients for thoracic surgery requiring one‑lung ventilation. Annals of Cardiac Anaesthesia. 2016 Apr; 19(2): 251-255.