Bahk J H, Oh Y S
Department of Anesthesiology, Seoul National University College of Medicine, Korea.
Anesth Analg. 1998 Jun;86(6):1271-5. doi: 10.1097/00000539-199806000-00026.
The double-lumen tube (DLT) is the mainstay of one-lung ventilation (OLV). We sought to determine whether this new intubation maneuver using an endobronchial cuff pressure could be substituted for verification by fiberoptic bronchoscope (FOB) in most conditions requiring left-sided DLT. Seventy-nine patients requiring video-assisted thoracoscopic surgery for pneumothorax or mediastinal mass, or open thoracotomy for lung or esophageal cancer were enrolled in this study. We used 35F (n = 23), 37F (n = 51), or 39F (n = 5) disposable polyvinyl chloride DLTs (Broncho-Cath; Mallinckrodt Medical Ltd., Athlone, Ireland), depending on the height and gender of the patients. The DLTs were inserted deeply until resistance was felt. At that time, the pilot of the endobronchial cuff was connected to the Control-Inflator (VBM Medizintechnik GmbH, Sulz am Neckar, Germany) via a three-way stopcock. The bronchial balloon was inflated with 1.0-2.0 mL of air through the stop-cock until approximately 30 cm H2O of cuff pressure was obtained. The DLT was slowly withdrawn until the pressure of the Control-Inflator decreased to approximately half the peak pressure during the initial phase of removal. At that time, the bronchial balloon was deflated, and the DLT was advanced approximately 1.0 cm (1.5 cm for the 39F DLT); using FOB, its position was checked by an independent observer not involved in positioning the DLTs. The ideal position was defined as that in which the carina was located at the same level with the middle 5 mm between the proximal margin of the endobronchial balloon and the circumferential black mark. In 50 patients the position was ideal, and in 27 patients it was not ideal but was within the margin of the safety. There were only two failures. We conclude that if a FOB is unavailable or inapplicable, this simple and new maneuver may be used as a substitute during the positioning of DLTs.
The correct position of the double-lumen tube is vital for one-lung ventilation, which has been confirmed with a fiberoptic bronchoscope. We devised a simple maneuver to position the double-lumen tube correctly without a fiberoptic bronchoscope.
双腔支气管导管（DLT）是单肺通气（OLV）的主要工具。我们试图确定在大多数需要左侧DLT的情况下，这种使用支气管内套囊压力的新插管操作是否可以替代纤维支气管镜（FOB）进行验证。本研究纳入了79例因气胸或纵隔肿物需要行电视辅助胸腔镜手术，或因肺癌或食管癌需要行开胸手术的患者。根据患者的身高和性别，我们使用了35F（n = 23）、37F（n = 51）或39F（n = 5）的一次性聚氯乙烯DLT（支气管导管；Mallinckrodt Medical Ltd.，爱尔兰阿斯隆）。将DLT深深插入直至感觉到阻力。此时，支气管内套囊的导气管通过一个三通旋塞连接到控制充气器（VBM Medizintechnik GmbH，德国内卡河畔苏尔茨）。通过旋塞向支气管气囊注入1.0 - 2.0 mL空气，直到套囊压力达到约30 cmH₂O。缓慢拔出DLT，直到控制充气器的压力在拔出初始阶段降至峰值压力的约一半。此时，放气支气管气囊，将DLT向前推进约1.0 cm（39F DLT推进1.5 cm）；由一名不参与DLT定位的独立观察者使用FOB检查其位置。理想位置定义为隆突位于支气管内气囊近端边缘与圆周黑色标记之间中间5 mm的同一水平处。50例患者的位置理想，27例患者的位置不理想但在安全范围内。仅出现两例失败情况。我们得出结论，如果没有FOB或无法使用FOB，这种简单的新操作可在DLT定位过程中用作替代方法。
双腔支气管导管的正确位置对于单肺通气至关重要，这已通过纤维支气管镜得到证实。我们设计了一种简单的操作方法，无需纤维支气管镜即可正确定位双腔支气管导管。
