Abstract
Objective The benefits and risks of using double lumen tube (DLT) in open thoracotomy are not well studied and the relative contraindication for using it in cases of endobronchial tumours is not proven. In this study, we compared our experience with using DLT versus single lumen tube (SLT) for anesthesia in patients requiring an open thoracotomy for resection of endobronchial tumours. Methods A prospective observational study was performed in a single tertiary care university hospital in patients with endobronchial tumours anesthetized with single and double lumen tubes for open thoracotomy procedures over a period from 2010 till 2018. Results One hundred and six patients with endobronchial tumours were studied. There were 76 males. Median age was 32 years (14 - 62). In 96 cases, endobronchial pathology was a typical carcinoid. 58 patients were anesthetized using a DLT and 48 using a SLT. Four cases of near miss from potentially fatal intraoperative tumour migration occurred in the SLT group (p = 0.025). There was only one case of mild tumour bleeding from the DLT group and time of insertion was longer (16.2 vs. 4.5 min p Conclusions We conclude that it is safe to place a double lumen endo tracheal tube for patients with endobronchial tumours requiring open lobectomies or bronchoplastic procedures. An additional benefit of DLT use is increasing surgical satisfaction by reducing spillage and tidal volume loss during surgical anastomosis of the open airway.
Highlights
Double-lumen endotracheal tube (DLT) insertion is the most common anesthetic technique to achieve lung separation
We compared our experience with using double lumen tube (DLT) versus single lumen tube (SLT) for anesthesia in patients requiring an open thoracotomy for resection of endobronchial tumours
We will compare our experience in a tertiary referral centre with using DLT versus single lumen tube for anesthesia in patients requiring an open thoracotomy for resection of endobronchial tumours via anatomical resections or bronchoplastic procedures
Summary
Double-lumen endotracheal tube (DLT) insertion is the most common anesthetic technique to achieve lung separation. Each lumen has its cuff that is inflated to create the required seal. This allows the anesthetist to ventilate both lungs or the right or left lungs independently [1]. The classic indications for a DLT in achieving single lung ventilation are to confine infections or bleeding to one lung, severe hypoxemia in single lung pathology (e.g. bronchopleural fistulae and major bronchial disruption) and for patients undergoing thoracic surgery procedures to achieve a static field and improve visualization. In video assisted thoracoscopic surgery (VATS), DLT is an absolute indication and failure to achieve single lung ventilation precludes a VATS procedure in most cases [2]
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