Double-lumen Tube Group Research Articles

A Clinical Comparison of 2 Bronchial Blockers Versus Double-Lumen Tubes for One-Lung Ventilation

To compare the quality of lung collapse, time, and number of attempts required to achieve lung isolation, and incidence of intraoperative malpositioning between the EZ blocker (EZB), Fuji Uniblocker (UB), and the left-sided double lumen tube (DLT). Prospective, randomized clinical trial. Single tertiary-level, university-affiliated hospital. Eighty-nine patients undergoing elective open thoracotomies or video-assisted thoracoscopic surgery. The 89 patients were randomized to receive a DLT, UB, or EZB for one-lung ventilation. The quality of lung collapse at the time of pleural opening and 10 and 20 minutes thereafter were assessed by the surgeon using the Lung Collapse Score (LCS; 0=no lung collapse to 10=best lung collapse). The time and number of attempts required to achieve lung isolation and the number of repositions required during surgery were measured. Tracheobronchial tree measurements were performed by radiologists from preoperative computed tomography imaging. The surgeon remained blinded to the type of device used. Twenty-nine patients were randomized to the DLT group and 30 patients to each of the EZB and UB groups. The LCSs among the groups at pleural opening and 10 minutes after pleural opening were not significantly different (p=0.34 and p=0.08, respectively). However, at 20 minutes after the pleural opening, the LCSs were significantly different among groups (p=0.02), with median scores being significantly lower for DLT (9 [IQR 8-9]) than for EZB (9 [IQR 9-10]; p=0.04) and UB (9.5 [IQR 9-10]; p=0.02). Lung isolation was achieved fastest in the DLT group (p < 0.01). The frequency of difficult placement did not significantly differ among groups, although it occurred most frequently in UB (n=7; 23.3%). Intraoperative repositioning also occurred most often with the UB (n=15; 50.0%). The EZB had the greatest number of cases requiring >2 repositions (n=4, 13.3%). There were no differences between preoperative airway measurements and time to isolation or incidence of intraoperative repositioning among the groups. The LCS was comparable among the 3 devices until 20 minutes after pleural opening, when better scores were obtained in the bronchial blocker groups. Lung isolation was achieved fastest with the DLT. The EZB had the highest incidence of cases requiring >2 intraoperative repositions, mostly occurring in R-sided surgery. For L-sided surgery, the EZB performed equally to the UB. This suggests that using the EZB for R-sided video-assisted thoracoscopic surgery may be suboptimal. Preoperative airway dimensions did not correlate with time to achieve isolation or incidence of intraoperative malpositioning.

Comparison of silicone double-lumen tube and polyvinyl chloride single-lumen tube in fiberoptic tracheal intubation on a difficult airway model: a randomized controlled non-inferiority trial

The management of patients with history or suspicion of difficult intubation can be challenging, especially in surgical procedures requiring one-lung ventilation. The ease of insertion of silicone double lumen tube (DLT) have previously been shown to be comparable to polyvinyl single lumen tube (SLT) in fiberoptic bronchoscope (FOB) tracheal intubation. Hence, in difficult airway situation, we hypothesized that the performance of insertion of silicone DLT would also be non-inferior to polyvinyl SLT in FOB intubation. We used a neck collar to mimic patients with difficult airway. 80 patients who required one-lung ventilation were enrolled in a prospective, randomized, non-inferiority trial. Patients were randomly allocated to the DLT or SLT groups (SLT with bronchial blocker). Neck collar was supplied to all patients before FOB intubation. The time of insertion for FOB, railroading, tracheal intubation, and total procedure were measured. The difficulty of railroading was evaluated in 4 grades. In the DLT group, the railroading was significantly shorter and easier comparing to the SLT group. The total procedure was also simpler and faster in the DLT group. While simulated difficult airways may not fully replicate actual difficult airways, we suggest that fiberoptic intubation with silicone DLT could be a feasible first-line option for patients with expected difficult airways requiring lung separation, unless the size of the DLT relative to the patient’s airway is problematic.Trial registration: NCT03392766.

Clinical application of intubation-free anesthesia in radical resection of lung cancer.

In recent years, video-assisted thoracic surgery (VATS) has become increasingly widespread. However, the implementation of VATS requires the assistance with lung isolation techniques. Spontaneous breathing with laryngeal masks is also increasingly used in VATS. However, evidence on the characteristics of intubated anesthesia is insufficient. This study aimed to explore whether intubation-free anesthesia has more advantages than other intubation methods in the clinical setting. Patients with lung tumors who underwent VATS in our hospital between June 2022 and October 2022 were included in the study. Perioperative data of patients, including basic information, intraoperative hemodynamic changes, postoperative inflammatory indicators, and adverse reactions were obtained through the electronic medical record system. According to the protocol of airway management during anesthesia, participants were divided into the following groups: laryngeal mask with spontaneous breathing group (LMSB group), laryngeal mask combined with bronchial blocker group (LM + BB group), double-lumen tube group (DLT group), and tracheal tube combined with bronchial blocker group (TT + BB group). All data were analyzed using SPSS 25.0 software. At baseline, patients in the LMSB and LM + BB groups had a lower body weight (P = 0.024). Systolic blood pressure (SBP), diastolic BP (DBP), and heart rate (HR) were significantly higher in the DLT group than in the non-intubated group during surgery (SBP: T1 P = 0.048, T4 P = 0.021, T5 P ≤ 0.001, T6 P ≤ 0.001, T7 P = 0.004; DBP: T5 P ≤ 0.001, T6 P ≤ 0.001, T7 P ≤ 0.001; HR: T1 P = 0.021, T6 P ≤ 0.001, T7 P = 0.007, T8 P ≤ 0.001). The input fluid (P = 0.009), urine output (P = 0.010), surgery duration (P = 0.035), and procalcitonin levels (P = 0.024) of the DLT group were also significantly higher than those of the other groups. The recovery duration of the LMSB group was significantly longer (P = 0.003) and the incidence of postoperative adverse reactions, mainly atelectasis, was higher (P = 0.012) than those of the other groups. Although the intubation-free anesthesia has less stimulation during operation and less postoperative inflammatory response, it has obvious adverse reactions after operation, which may be not the best anesthesia scheme for radical resection of lung cancer in VATS. https://www.chictr.org.cn/showproj.html?proj=182767, identifier ChiCTR2200066180.

Different Endotracheal Intubations for Non-Small Cell Lung Cancer Surgery: A Retrospective-Case-Matched Study on Postoperative Complications and Quality of Life.

Lung isolation and separation is still controversial in thoracic surgery. Preferences of the surgeon can drive the decision to use single- vs. double-lumen endotracheal intubation. We aimed to compare complications and quality of life (QOL) after radical lung cancer resection with a single-lumen tube (ST) and a double-lumen tube (DT) for patients with non-small cell lung cancer (NSCLC). A total of 309 patients who underwent radical lung cancer resection with video-assisted thoracoscopy-lobectomy were subsequently included in the study. Based on the type of endotracheal intubation tube used during surgery, we divided all the patients into a single-lumen tube group (ST-G) and double-lumen tube group (DT-G). Then, we applied propensity score matching (1:1) to balance the baseline characteristics between the two groups. The Analysis of Variance (ANOVA) of two-factor repeated measures data was performed to compare postoperative complications at three and six months after surgery and postsurgical QOL at baseline at one month, three months, six months, and twelve months. Within three months after surgery, patients in the ST-G presented less cough symptoms in Lung Cancer Symptom Scale (LCSS), lower cough symptom scores (CSS) (one month and three months, p < 0.05) and better performance of Leicester Cough Questionnaire (LCQ) scores in physical part (one month, three months and six months, p < 0.05) with better overall QOL (one month and three months, p < 0.05) than those in the DT-G. Patients with STs displayed less postoperative cough symptoms and higher overall QOL than those with DTs. Although DT is the gold standard for thoracic surgeries, we suggest that postoperative cough symptoms should be given sufficient attention by surgeons.

The association between double-lumen tube versus bronchial blocker and postoperative pulmonary complications in patients after lung cancer surgery.

BackgroundBoth double-lumen tube (DLT) and bronchial blocker (BB) are used for lung isolation in patients undergoing lung cancer surgery. However, the effects of different devices for lung isolation remain inconclusive. Present study was designed to investigate the association between the choice of the two devices and postoperative pulmonary complications (PPCs) in patients with lung cancer.MethodsIn this retrospective cohort study, patients who underwent lung cancer surgery between January 1, 2020 and October 31, 2020 were screened. Patients were divided into two groups according to different devices for lung isolation: DLT group and BB group. Primary outcome was the incidence of a composite of PPCs during postoperative in-hospital stay.ResultsA total of 1721 were enrolled for analysis, of them, 868 received DLT and 853 BB. A composite of PPCs was less common in patients with BB (25.1%, [214/853]) than those received DLT (37.9% [329/868] OR 0.582 95% CI 0.461-0.735 P < 0.001). Respiratory infection was less common in BB group (14.4%, [123/853]) than DLT group (30.3%, [263/868], P<0.001). The incidence of non-PPCs complications was not statistically significant between the 2 groups.ConclusionsFor patients undergoing surgery for lung cancer, the use of BB for lung isolation was associated with a reduced risk of PPCs when compared with DLT.

Postoperative Outcomes of Lung Separation With Double-Lumen Tubes and Bronchial Blockers.

The choice between a double-lumen tube (DLT) and a bronchial blocker (BB) for lung isolation remains controversial. The aim of this study was to determine if the features of these lung isolation devices affect postoperative pulmonary outcomes. We retrospectively identified claims by patients who underwent surgery under lung isolation in 2000-2012 in the Taiwan National Health Insurance Research Database. After matching for age, sex, and year of surgery, 1,898 patients were enrolled in a BB group and 5,694 in a DLT group. The risks of readmission in the first postoperative year with pulmonary complications, in-hospital death, and one-year mortality were estimated using conditional logistic regression analysis. Patients in the BB group had higher risks of readmission with pulmonary infection (adjusted odds ratio [aOR], 1.46; 95% confidence interval [CI], 1.22-1.74) or respiratory failure (aOR, 1.38; 95% CI, 1.09-1.76) in the first postoperative year as well as in-hospital death (aOR, 2.03; 95% CI, 1.40-2.94) and one-year mortality (aOR, 1.94; 95% CI, 1.60-2.35) than those in the DLT group after adjustment for the types of the surgeries, hospital accreditation level, underlying comorbidity, and a potentially difficult airway. Patients in the BB group had longer median (interquartile range) stays in the intensive care unit (1 [0-4] vs. 1 [0-3] days, P ＜ 0.001) and in hospital (16 [10-26] vs. 13 [8-22] days, P ＜ 0.001). Patients undergoing thoracic surgery are more likely to experience postoperative pulmonary complications if a BB than a DLT is used.

Postoperative Outcomes of Lung Separation With Double-Lumen Tubes and Bronchial Blockers.

Background The choice between a double-lumen tube (DLT) and a bronchial blocker (BB) for lung isolation remains controversial. The aim of this study was to determine if the features of these lung isolation devices affect postoperative pulmonary outcomes. Methods We retrospectively identified claims by patients who underwent surgery under lung isolation in 2000-2012 in the Taiwan National Health Insurance Research Database. After matching for age, sex, and year of surgery, 1,898 patients were enrolled in a BB group and 5,694 in a DLT group. The risks of readmission in the first postoperative year with pulmonary complications, in-hospital death, and one-year mortality were estimated using conditional logistic regression analysis. Results Patients in the BB group had higher risks of readmission with pulmonary infection (adjusted odds ratio [aOR], 1.46; 95% confidence interval [CI], 1.22-1.74) or respiratory failure (aOR, 1.38; 95% CI, 1.09-1.76) in the first postoperative year as well as in-hospital death (aOR, 2.03; 95% CI, 1.40-2.94) and one-year mortality (aOR, 1.94; 95% CI, 1.60-2.35) than those in the DLT group after adjustment for the types of the surgeries, hospital accreditation level, underlying comorbidity, and a potentially difficult airway. Patients in the BB group had longer median (interquartile range) stays in the intensive care unit (1 [0-4] vs. 1 [0-3] days, P ＜ 0.001) and in hospital (16 [10-26] vs. 13 [8-22] days, P ＜ 0.001). Conclusion Patients undergoing thoracic surgery are more likely to experience postoperative pulmonary complications if a BB than a DLT is used.

The disconnection technique with the use of a bronchial blocker for improving nonventilated lung collapse in video-assisted thoracoscopic surgery.

BackgroundOne-lung ventilation (OLV) is becoming an essential component of thoracic anesthesia. The two principal devices used for OLV are a double-lumen tube (DLT) and a bronchial blocker (BB). We hypothesized that the use of a BB with the disconnection technique would improve the quality of lung collapse in video-assisted thoracoscopic surgery (VATS).MethodsSeventy-five patients undergoing scheduled VATS were enrolled in this study and were randomly divided into two groups: a left-sided DLT group (Group D) and a BB with the disconnection technique group (Group B). OLV was initiated when the surgeon performed the skin incision. In Group D, the left channel of the DLT was opened to the air. In Group B, the lung was deflated via the disconnection technique, thus opening the breathing circuit to the air fifteen seconds after opening the pleura. The mean arterial pressure (MAP) and heart rate (HR) during induction; the quality of lung collapse 1 and 10 minutes after pleural opening; the time required for complete lung collapse; the correct placement of the device; and the number of patients suffering from a sore throat after surgery were recorded.ResultsCompared with the use of the DLT, the use of the BB with the disconnection technique was associated with a similar quality of lung collapse, a comparable required time for total lung collapse (P>0.05, respectively), a lower incidence of sore throat both when leaving the PACU and 24 hours after surgery (34.2% vs. 13.5%, 15.8% vs. 5.4%, P<0.05, respectively) and fewer hemodynamic fluctuations after intubation both one and ten minutes after pleural opening.ConclusionsThe use of a BB with the disconnection technique in VATS offers an effective method for improving the quality of lung collapse and reducing postoperative sore throat.

Virtues of Using a Double Lumen Tube for Anesthesia in Patients with Endobronchial Tumours Requiring Open Lung Resection or Bronchoplastic Procedures

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.

RETRACTED ARTICLE: Bronchial blocker versus double-lumen endobronchial tube in minimally invasive cardiac surgery

BackgroundTo compare the therapeutic value of a bronchial blocker (BB) with a double-lumen tube (DLT) in minimally invasive cardiac surgery (MICS).MethodsSixty patients who underwent MICS were randomized to use either a DLT (Group D, n = 30) or a BB (Group B, n = 29; one failed was omitted). The following data were collected: time of intubation and tube localization; incidence of tube displacement; postoperative sore throat and hoarseness; time of cardiopulmonary bypass; maintenance time for SpO2 < 90% (PaCO2 < 60 mmHg); mean arterial pressure and heart rate; SpO2, PaO2, PaCO2, EtCO2, mean airway pressure, and airway peak pressure; surgeons’ satisfaction with anesthesia; and short-term complications.ResultsThe times of intubation and tube localization were significantly longer in Group B than in Group D (P < 0.05). Patients in Group B exhibited significantly lower incidence of tube displacement, postoperative sore throat, and hoarseness when compared with patients in Group D (P < 0.05). Mean arterial pressure and heart rate were significantly lower in Group B than in Group D after tracheal intubation (P < 0.05). The mean airway pressure and airway peak pressure were significantly lower in Group B than in Group D after one-lung ventilation (P < 0.05). SpO2 and PaO2 in Group B were significantly higher than in group D after cardiopulmonary bypass (P < 0.05). No short-term postoperative complications were observed in patients of Groups B and D during 3 month follow-up.ConclusionBB can be a potential alternative to the conventional DLT for lung isolation in MICS. Trial registration: ChiCTR1900024250, July 2, 2019.

Efficacy and safety of Cohen Flex-Tip blocker and left double lumen tube in lung isolation for thoracic surgery: a randomized comparative study

BackgroundThe Cohen blocker is one of the lung isolation devices. Unfortunately, most anesthesiologists believe that its efficacy in inducing lung collapse is less than that of the double-lumen tube (DLT). This study has been performed to compare the adequacy of lung collapse and the adverse effects between the Cohen blocker and the left DLT for thoracic operations.MethodForty patients with an age range of 25–50 years and American Society of Anesthesiologist (ASA) physical status I-II of either sex were subjected to an elective thoracic operation with lung isolation achieved by either a left DLT or a Cohen blocker. The patients were distributed randomly into two equal groups (n = 20): group (I) left DLT and group (II) Cohen-blocker. The following parameters were measured: the number of intubation attempts, time for correct positioning, and lung collapse assessment grades either spontaneous (grade 1), assisted with suction (grade II), or with manual disconnection maneuver (grade III). Sore throat and hoarseness were compared between the two groups.ResultsThe first intubation attempt success rate was 90% and 95% (p = 0.871), while the second attempt success rate was 10% and 5% (p = 0.617) in the left DLT and Cohen blocker groups, respectively (non-significant p value). The time for correct positioning was significantly shorter in the left DLT group than in the Cohen blocker group (p < 0.001). Lung collapse showed similar results between the two groups (p = 0.803) regardless of the grade of lung collapse: either spontaneous (grade I), assisted with suction (grade II), or with manual disconnection maneuver (grade III). The left DLT group showed a significantly higher frequency of hoarseness (p = 0.017) and sore throat (p = 0.028) than the Cohen blocker group.ConclusionWe concluded that Cohen blocker can be used as a good alternative to the left DLT for its efficiency in inducing lung collapse with minimal incidence of postoperative hoarseness and sore throat.

The use of ETView endotracheal tube for surveillance after tube positioning in patients undergoing lobectomy, randomized trial.

The ETView tracheoscopic ventilation tube (TVT) is a tracheal tube (TT) incorporating a video camera and a light source in its tip. The view from the tip appears continuously on a portable monitor in the anesthesia area. We evaluated the effectiveness and usefulness of the single/double ETView TVT in monitoring the tracheal tube position during general anesthesia undergoing video-assisted thoracoscopic lobectomy.Eighty-three patients with pulmonary bullae (American Society of Anesthesiologists (ASA) I-III) undergoing lobectomy, with general anaesthesia, were included. Patients were randomly assigned to 3 groups, based on the tube ETView double-lumen tube (VDT), ETView single-lumen tube (VST), or traditional double lumen tube (DT).All 83 patients’ intubations were successful to achieve 1-lung ventilation: 74 patients at the first attempt (22/26 in VDT, 26/28 in VST, 26/29 in DT group) and 9 patients at the second attempt. The time to achieve 1-lung ventilation with the VDT was 58.5 ± 21.5 (mean ± SD) seconds, the VST was 38.2 ± 10.1 (mean ± SD) seconds, and the DT group was 195.5 ± 40.3 (mean ± SD) seconds. During operations, the ETView tubes provided continuous airway visualization in all patients; a good view was obtained in 24/25 patients in VDT/VST, moderate in 4/12 patients in VDT/VST, and poor in 1/1 patients in VDT/VST. When the patient left the postanesthesia care unit, all had sore throat and 26/15/25 patients in VDT/VST/DT group had hoarseness. All had good outcomes of the surgical operations.We found the ETView tube to be helpful in the endotracheal intubation and continuous surveillance of tube position in patients with video-assisted thoracoscopic lobectomy. The ETView single lumen endotracheal tube had fewer associated complications and is superior to the 2 double-lumen tubes.

Replacing a double-lumen tube with a single-lumen tube or a laryngeal mask airway device to reduce coughing at emergence after thoracic surgery: a randomized controlled single-blind trial.

Coughing episodes occur frequently at extubation after thoracic surgery, and this may be due in part to the double-lumen tube (DLT). In this study, the DLT was replaced with either a single-lumen endotracheal tube (ETT) or a laryngeal mask airway (LMA) device or left in place, and the incidence of coughing at emergence was compared between the three groups. Fifty-eight adults scheduled for thoracic surgery with a DLT were included. Exclusion criteria were an anticipated difficult airway, obesity, and contraindication to the use of an LMA ProSeal™ (LMA-P). After surgery but before emergence, patients were randomized to having the DLT (1) removed and replaced by an LMA-P (LMA-P Group), (2) removed and replaced by an ETT (ETT Group), or (3) left in place (DLT Group). The primary outcome was the number of coughing episodes at extubation. Among 184 patients screened, 124 did not meet inclusion criteria, and two patients, both in the ETT Group, were excluded after randomization, leaving 20, 18, and 20 patients in the LMA-P, ETT, and DLT Groups, respectively. There were fewer coughing episodes (median [quartiles]) in the LMA-P Group than in the DLT Group (0[0-1] vs 2[1-3], respectively; P = 0.01). In the DLT Group, 90% of patients coughed at least once. This incidence was not significantly different in the ETT Group (83%; P = 0.222) but was significantly reduced in the LMA-P Group (35%; P < 0.001). No patient had oxygen desaturation during airway exchange or at extubation. The incidence and severity of hoarseness and sore throat were similar in all groups. Coughing at extubation after thoracic surgery can be reduced if the DLT is replaced by an LMA-P before emergence. The number of patients in this trial was too small to evaluate the risks associated with exchanging the airway device. This trial was registered at ClinicalTrials.gov: NCT00925613.

Disconnection Technique With a Bronchial Blocker for Improving Lung Deflation: A Comparison With a Double-Lumen Tube and Bronchial Blocker Without Disconnection

One-lung ventilation (OLV) is accomplished with a double-lumen tube (DLT) or a bronchial blocker (BB). The authors compared the effectiveness of lung collapse using DLT, BB, and BB with the disconnection technique. Prospective, randomized, blind trial. A university hospital. Fifty-two patients undergoing elective pneumothorax surgery. Patients were assigned randomly to 1 of 3 groups: The DLT group (group 1), the BB group (group 2), and the BB with the disconnection technique group (group 3). The authors modified the disconnection technique in group 3 as follows: (1) turned off the ventilator and opened the adjustable pressure-limiting valve, allowing both lungs to collapse and (2) after loss of the CO2 trace on the capnograph, inflated the blocker cuff and turned on the ventilator, allowing only dependent-lung ventilation. Five and ten minutes after OLV, the degree of lung collapse was assessed by the surgeon, who was blinded to the isolation technique. The quality of lung collapse at 5 and 10 minutes was significantly better in groups 1 and 3 than in group 2. No significant differences were observed for the degree of lung collapse at any time point between groups 1 and 3. The average time for loss of the CO2 trace on the capnograph was 32.3±7.0 seconds in group 3. A BB with spontaneous collapse took longer to deflate and did not provide equivalent surgical exposure to the DLT. The disconnection technique could be helpful to accelerate lung collapse with a BB.

Efficiency, Efficacy, and Safety of EZ-Blocker Compared with Left-sided Double-lumen Tube for One-lung Ventilation

Double-lumen tubes (DLTs) or bronchial blockers are commonly used for one-lung ventilation. DLTs are sometimes difficult or even impossible to introduce, and the incidence of postoperative hoarseness and airway injuries is higher. Bronchial blockers are more difficult to position and need more frequent intraoperative repositioning. The design of a Y-shaped bronchial blocker, the EZ-Blocker (Teleflex Life Sciences Ltd., Athlone, Ireland) (EZB), combines some advantages of both techniques. The objective of this study was to assess whether EZB performs clinically better than left-sided DLTs (Broncho-cath; Mallinckrodt, Athlone, Ireland) without causing more injury. Primary outcome was the frequency of initial malpositions. Eligible patients were adults scheduled for surgery requiring one-lung ventilation who met criteria for placement of both devices. In this parallel trial, 100 consecutive and blinded patients were assigned randomly using a computer-generated list to two groups. The incidence of malposition and ease and time of placement were recorded. Blinded assessors investigated quality of lung deflation, postoperative complaints, and damage to the airway. Placement of a DLT was unsuccessful twice. The incidence of initial malposition was high and comparable between EZBs (37 of 50) and DLTs (42 of 49) (P = 0.212). Placing single-lumen tubes and EZBs took more time but was rated easier. Quality of lung deflation was comparable. Fewer patients in the EZB group complained of sore throat at day 1. There was a higher incidence of tracheal hematoma and redness and bronchial hematoma in the DLT group. The EZB is an efficient and effective device for one-lung ventilation and causes less injury and sore throat than a DLT.

Back To Blockers?

Back To Blockers?

Cardiovasular changes after placement of a classic endotracheal tube, double-lumen tube, and Laryngeal Mask Airway

Study Objective To compare hemodynamic responses, P wave dispersion (Pd), and QT dispersion (QTd) after placement of a classic endotracheal tube (ETT), double-lumen tube (DLT), or Laryngeal Mask Airway (LMA). Design Prospective study. Setting Outpatient surgery center. Patients 75 adult, ASA physical status 1 and 2 patients undergoing cystoscopy and thoracoscopic surgery. Interventions Patients were randomized to undergo placement of an ETT (Group T; n = 25), DLT (Group D; n = 25), or LMA (Group L; n = 25). Anesthesia was induced by etomidate 0.3 mg/kg and fentanyl 1.0 μg/kg, and maintained with nitrous oxide, oxygen, 2% to 3% sevoflurane, and rocuronium 0.5 mg/kg. Measurements Mean arterial pressure (MAP) and heart rate (HR) were recorded immediately before intubation and after intubation at one, 3, 5, 10,15, 20, 25, and 30 minutes after intubation/airway insertion. Results QT dispersion after tube placement was significantly higher than before tube placement in Group D ( P = 0.0001) and Group L ( P = 0.03). Mean arterial pressure and HR in Group T were significantly higher than in Group L at the first minute after tube placement ( P = 0.02). Heart rate and MAP at baseline were significantly higher than the other measurement times in Groups T and D ( P < 0.01). Conclusions The LMA caused no change in Pd, HR, or MAP values during or after airway placement, but caused QTd after airway insertion. The ETT caused a sudden increase at the first minute after tube placement, without any Pd or QTd. In addition, DLT caused QTd without any serious change in hemodynamics.

Efficacy of Coopdech bronchial Mocker combined with a strengthened single-lumen tube for airway management in patients undergoing upper mediastinal tumor resection

Objective To evaluate the efficacy of Coopdech bronchial blocker combined with a strengthened single-lumen tube for airway management in patients undergoing upper mediastinal tumor resection. Methods Twenty-two ASA Ⅱ or Ⅲ patients, aged 24-66 yr, weighing 48-78 kg, scheduled for elective resection of upper mediastinal tumor, were randomly divided into 2 groups (n=11 each):double-lumen tube group(groupⅠ) and Coopdech bronchial blocker combined with a strengthened single-lumen tube group(group Ⅱ).One-lung ventilation was achieved with a double-lumen tube in groupⅠ. The Coopdech bronchial blocker combined with a strengthened single-lumen tube was used for airway management and the Coopdech bronchial blocker was used for lung isolation when one-lung ventilation was required in group Ⅱ. The fiberoptic bronchoscope was used to assist endotracheal tube positioning in both groups. The intubation time, positioning time, the number of patients required for tube displacement, the number of fiberoptic bronchoscopy, increase in airway peak pressure, degree of lung collapse, postoperative sore throat and hoarseness, and the number of patients needing ventilator-assisted ventilation were recorded. Results The intubation time was significantly shorter, the number of patients required for tube displacement was significantly smaller,and the rate of increase in airway peak pressure and incidences ofpostoperative sore throat and hoarseness were significantly lower in group Ⅱ than in group Ⅰ (P＜0.05 or0.01). Conclusion The efficacy of the Coopdech bronchial blocker combined with a strengthened single-lumen tube for airway management is better in patients undergoing upper mediastinal tumor resection than the double-lumen tube. Key words: Respiration, artificial; Mediastium; Neoplasms

A Comparison of the Deflecting-Tip Bronchial Blocker With a Wire-Guided Blocker or Left-Sided Double-Lumen Tube

To compare a new bronchial blocker, the Cohen blocker, with the Arndt blocker and a left double-lumen tube (DLT). A prospective, randomized, controlled trial. University hospital. Forty-eight patients undergoing lung surgery. Intubation with 1 of the 3 devices. Comparisons among groups included (1) time for initial positioning, (2) degree of lung collapse at pleura opening, and (3) number of intraoperative fiberoptic examinations. Positioning of the Cohen blocker (256 [166-341] seconds; median [interquartile range]) took no longer compared with the Arndt blocker (253 [184-305] seconds), and there was a trend toward difference between the 2 blockers and the DLT (137 [102-199] seconds) (p = 0.07). The time to place the Cohen blocker was longer in cases of left bronchus occlusion compared with a right one (340 [300-450] v 170 [124-259] seconds, p = 0.02); they were similar in the Arndt group. The degree of lung collapse was different among groups (p = 0.05), but the difference between any pair did not reach statistical significance. The number of patients who required at least 1 additional FOB examination was not statistically different (50% of patients in each blocker group v 19% in the DLT group). There was a trend toward a difference between times to place a bronchial blocker and the DLT. The Cohen blocker is more difficult to position in the left main bronchus than in the right one.

Sore Throat or Hoarse Voice with Bronchial Blockers or Double-Lumen Tubes for Lung Isolation: A Randomised, Prospective Trial

Double-lumen endotracheal tubes and bronchial blockers allow lung isolation for one-lung ventilation. Few studies, however, directly compare these devices. Further, a new endobronchial blocker (Coopdech) is available in some countries. Our primary hypothesis was that bronchial blockers would be associated with less sore throat or hoarse voice than double-lumen tubes. Secondary outcomes were successful one-lung ventilation and surgical access. In this prospective trial, 120 Chinese patients undergoing elective surgery were randomly assigned to one of four groups of 30 patients: Coopdech blocker, Arndt blocker Univent tube or double-lumen tube. Postoperative sore throat and hoarse voice were assessed in the recovery room and 24 hours after surgery. The incidence and severity of sore throat or hoarse voice was less in the blocker groups than double-lumen tube group: Coopdech 13%, Arndt 20%, Univent 30% and double-lumen tube 60%, P < 0.001. The blocker groups did not significantly differ P = 0.28. Compared to the double-lumen tubes the bronchial blockers took about two minutes less to position but five minutes longer for lung deflation. Surgical exposure was uniformly good across the four groups. We conclude that clinical use of the Coopdech endobronchial blocker is similar to the Arndt and Univent blockers and that all three are associated with less sore throat or hoarse voice than double-lumen tubes.