Trachway Intubating Stylet Facilitates the Double-Lumen Endobronchial Tube Placement in Patients with Limited Mouth Opening

Wen-Ming Chuang

doi:10.23937/2377-4630/1410057

Abstract

Intubation for one lung ventilation in patients with difficult airways can be a challenge. Severely limited mouth opening restricts the use of direct laryngoscopy or video-assisted laryngoscopy. We present two patients with limited mouth opening undergoing video-assisted thoracoscopic decortication, who were successfully intubated with left-sided double-lumen endobronchial tube (DLT) using the Trachway® intubating stylet. This technique provides a safe and reliable method for DLT intubation in patients with limited mouth opening.

Highlights

Thoracic surgeries in patients with difficult airways always make the anesthesiologist face the challenges of lung isolation
We present two patients with limited mouth opening undergoing video-assisted thoracoscopic decortication, who were successfully intubated with left-sided double-lumen endobronchial tube (DLT) using the Trachway® intubating stylet
One lung ventilation is achieved with DLT in most thoracic surgery, for the advantages of more rapid lung deflation, less intraoperative tube displacement, and allowing suctioning and re-expanding the operative lung during surgery [4]

Summary

Introduction

Thoracic surgeries in patients with difficult airways always make the anesthesiologist face the challenges of lung isolation. One lung ventilation (OLV) usually can be achieved with double lumen endobronchial tube (DLT) or bronchial blocker. In patients with difficult airways, the first step is endotracheal intubation with a single-lumen endotracheal tube (ETT), which for further an independent bronchial blocker advanced in or being replaced by a DLT over an exchange catheter [1,2,3]. The quality and time-consuming of lung deflation when using bronchial blocker in video-assisted thoracoscopic surgery (VATS) remains a debate [4,5]. One of major cause of difficult intubation, restricts the use of direct laryngoscopy or video-assisted laryngoscopy. Its efficacy in DLT intubation in patients with difficult airways has not yet been reported. We are presenting two patients with limited mouth opening who were successfully intubated orotracheally with left-sided DLT using Trachway® intubating stylet.

Case Report

Findings

Discussion