From Department of Anaesthesiology and Pain Medicine (J-WP, JHJ, HP, YKB, S-JP, S-HH, J-HK), Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam (S-WC) and Department of Anaesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, South Korea (S-HH, J-HK).
Eur J Anaesthesiol. 2020 Jun;37(6):466-473. doi: 10.1097/EJA.0000000000001216.
Postoperative sore throat and airway injuries are relatively common after double-lumen tube (DLT) intubation.
The current study aimed to evaluate the effects of fibreoptic-guided advance of DLT on postoperative sore throat and airway injuries associated with intubation.
A randomised controlled study.
Tertiary hospital, Seongnam, Korea, from January 2018 to January 2019.
One hundred twenty three patients undergoing one-lung ventilation with a left-side DLT were randomised into two groups: 62 in the conventional group and 61 in the fibreoptic-guided group.
After entering the glottis, the DLT was rotated left 90° and advanced blindly into the left main bronchus in the conventional group. In the fibreoptic-guided group, DLT was advanced into the main bronchus under the guide of fibreoptic bronchoscope, which had been passed through the bronchial lumen and inserted into the left main bronchus.
The primary outcome was postoperative sore throat at 24 h after operation. The airway injuries were also examined using a bronchoscope during extubation.
At postoperative 24 h, the fibreoptic-guided group showed lower pain score (P = 0.001) and lower incidence (risk ratio [95% CI]: 0.2 [0.1 to 0.5], P < 0.001) of sore throat, compared with the conventional group. Moreover, tracheal injury was more severe in the conventional group than in the fibreoptic group (P = 0.003). Vocal cord injuries also occurred less frequently in the fibreoptic-guided group (risk ratio [95% CI]: 0.4 [0.2 to 1.0], P = 0.036).
The fibreoptic-guided advancement seems to reduce irritation to the airway, leading less postoperative complications.
ClinicalTrials.gov, registration number: NCT03368599.
双腔管（DLT）插管后，术后咽喉痛和气道损伤较为常见。
本研究旨在评估纤维支气管镜引导下 DLT 推进对与插管相关的术后咽喉痛和气道损伤的影响。
随机对照研究。
韩国城南市的一家三级医院，时间为 2018 年 1 月至 2019 年 1 月。
123 例接受左侧 DLT 单肺通气的患者被随机分为两组：常规组 62 例，纤维支气管镜引导组 61 例。
进入声门后，常规组将 DLT 向左旋转 90°，盲目推进至左主支气管。在纤维支气管镜引导组中，在纤维支气管镜的引导下将 DLT 推进至主支气管，纤维支气管镜已经通过支气管腔并插入左主支气管。
主要结局为术后 24 小时的术后咽喉痛。在拔管期间还使用支气管镜检查气道损伤。
术后 24 小时，纤维支气管镜引导组疼痛评分较低（P=0.001），咽喉痛发生率较低（风险比[95%CI]：0.2[0.1 至 0.5]，P<0.001），常规组。此外，常规组的气管损伤比纤维支气管镜组更严重（P=0.003）。纤维支气管镜引导组声带损伤也较少见（风险比[95%CI]：0.4[0.2 至 1.0]，P=0.036）。
纤维支气管镜引导下推进似乎可以减少对气道的刺激，从而减少术后并发症。
ClinicalTrials.gov，注册号：NCT03368599。
