Selective left bronchial suctioning in infants and children.

Abstract

The study population was composed of 271 infants and children of both sexes between the ages of 1 month and 13 yr who were scheduled for various types of surgical, orthopedic, or otolaryngologic operations at Osaka Kohseinenkin Hospital. After induction of general anesthesia, each patient was intubated with a cuffed or uncuffed endotracheal tube (Portex Inc.. Hythe. Kent, England) that had an ID of 4 to 7 mm. Unilateral bronchial intubation and auscultation were used to delermine the clinical distance from incisor teeth to canna; the endotracheal lube was then withdrawn 1 to 4 cm. depending on body height, and fixed at the center of the mouth. In each patient, we attempted to catheterize the left bronchus using each of the following techniques: a supine position with an 8-Fr or 10-Fr curved-tip catheter (Portex); a supine position with an 8-Fr or 10-Fr straight catheter (Portex); and a left lateral position with an 8-Fr or 10-Fr straight catheter. The patient's head was always in a midline position, which seems to increase the rate of left bronchial eatheterization (8). Fach time a catheter was inserted, the location of its tip was verified by a device of our own invention (9). Each technique was repeated five times in each patient, and all bronchial catheterizations were attempted either before or at the end of the operation, after the patient had received 100% oxygenation for 3 to 5 min. When patients were in the supine position, the curved-tip catheter entered the left bronchus in 11 I 1 (82%) out of 1355 attempts: in 219 patients, the catheter entered the left bronchus from one to five times: in 171 of these 219 patients, the catheter entered the left bronchus five times. By comparison, the straight catheter entered the left bronchus in only 155 (11%) of 1355 attempts; in 66 patients, the catheter entered the left bronchus one to five times. When patients were in the left lateral position, the straight catheter entered the left bronchus in 261 (19%) of 1355 attempts. In only 19 patients did the catheter enter the left bronchus on all five attempts.