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Cameron RB, Peacock WJ, Chang XG, Shin JS, Hoftman N. Double lumen endobronchial tube intubation: lessons learned from anatomy. BMC Anesthesiol 2024; 24:150. [PMID: 38641603 PMCID: PMC11027328 DOI: 10.1186/s12871-024-02517-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 03/28/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND Double lumen endobronchial tubes (DLTs) are frequently used to employ single lung ventilation strategies during thoracic surgical procedures. Placement of these tubes can be challenging even for experienced clinicians. We hypothesized that airway anatomy, particularly of the glottis and proximal trachea, significantly impacts the ease or difficulty in placement of these tubes. METHODS Images from 24 randomly selected Positron Emission Tomography - Computed Tomography (PET-CT) scans were evaluated for several anatomic aspects of the upper airway, including size and angulation of the glottis and proximal tracheal using calibrated CT measurements and an online digital protractor. The anatomic issues identified were confirmed in cadaveric anatomic models. RESULTS Proximal tracheal diameter measurements in PET-CT scans demonstrated a mean ± standard deviation of 20.4 ± 2.5 mm in 12 males and 15.5 ± 0.98 mm in 12 females (p < 0.001), and both were large enough to accommodate 39 French and 37 French DLTs in males and females, respectively. Subsequent measurements of the posterior angulation of the proximal trachea revealed a mean angle of 40.8 ± 5.7 degrees with no sex differences. By combining the 24 individual posterior tracheal angles with the 16 angled distal tip measurements DLTs (mean angle 24.9 ± 2.1 degrees), we created a series of 384 patient intubation angle scenarios. This data clearly showed that DLT rotation to a full 180 degrees decreased the mean intubation angle between the DLT and the proximal trachea from a mean of 66.6 ± 5.9 to only 15.8 ± 5.9 degrees. CONCLUSIONS Rotation of DLTs a full 180 instead of the recommended 90 degrees facilitates DLT intubations.
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Affiliation(s)
- Robert B Cameron
- Division of Thoracic Surgery, Department of Surgery, David Geffen School of Medicine at UCLA and the Division of Thoracic Surgery, Department of Surgery and Perioperative Care, West Los Angeles VA Medical Center, Los Angeles, CA, USA
| | - Warwick J Peacock
- Department of Surgery, David Geffen School of Medicine at UCLA and the Division of Thoracic Surgery, Los Angeles, USA
| | - Xinlian Grace Chang
- Department of Surgery, David Geffen School of Medicine at UCLA and the Division of Thoracic Surgery, Los Angeles, USA
| | - John S Shin
- Department of Anesthesiology, David Geffen School of Medicine at UCLA and the Department of Anesthesiology, West Los Angeles VA Medical Center, Los Angeles, CA, USA.
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, University of California, 757 Westwood Plaza, Suite 3325, Los Angeles, CA, 90095, USA.
| | - Nir Hoftman
- Department of Anesthesiology, David Geffen School of Medicine at UCLA and the Department of Anesthesiology, West Los Angeles VA Medical Center, Los Angeles, CA, USA
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Irouschek A, Schmidt J, Birkholz T, Sirbu H, Moritz A. Video double-lumen tube for one lung ventilation: implementation and experience in 343 cases of routine clinical use during the first 20 months of the SARS-CoV-2 pandemic. J Cardiothorac Surg 2024; 19:218. [PMID: 38627789 PMCID: PMC11020909 DOI: 10.1186/s13019-024-02663-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 03/20/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Double-lumen tubes (DLTs) are the preferred device for lung isolation. Conventional DLTs (cDLT) need a bronchoscopic position control. Visualisation of correct DLT positioning could be facilitated by the use of a video double-lumen tube (vDLT). During the SARS-CoV-2-pandemic, avoiding aerosol-generation was suggesting using this device. In a large retrospective series, we report both general and pandemic related experiences with the device. METHODS All anesthesia records from patients aged 18 years or older undergoing surgery from April 1st, 2020 to December 31st, 2021 in the department of thoracic surgery requiring intraoperative lung isolation were analyzed retrospectively. RESULTS During the investigation period 343 left-sided vDLTs (77.4%) and 100 left-sided cDLTs (22.6%) were used for one lung ventilation. In the vDLT group bronchoscopy could be reduced by 85.4% related to the cDLT group. Additional bronchoscopy to reach or maintain correct position was needed in 11% of the cases. Other bronchoscopy indications occured in 3.6% of the cases. With cDLT, in 1% bronchoscopy for other indications than conforming position was observed. CONCLUSIONS The Ambu® VivaSight™ vDLT is an efficient, easy-to-use and safe airway device for the generation of one lung ventilation in patients undergoing thoracic surgery. The vDLT implementation was achieved easily with full interchangeability to the left-sided cDLT. Using the vDLT can reduce the need for aerosol-generating bronchoscopic interventions by 85.4%. Continuous video view to the carina enabling position monitoring of the DLT without need for bronchoscopy might be beneficial for both employee's and patient's safety.
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Affiliation(s)
- Andrea Irouschek
- Department of Anesthesiology, University Hospital Erlangen, Faculty of Medicine, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen, Germany.
- Department of Anesthesiology, University Hospital Erlangen, Krankenhausstr. 12, 91054, Erlangen, Germany.
| | - Joachim Schmidt
- Department of Anesthesiology, University Hospital Erlangen, Faculty of Medicine, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Torsten Birkholz
- Department of Anesthesiology, University Hospital Erlangen, Faculty of Medicine, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Horia Sirbu
- Department of Thoracic Surgery, University Hospital Erlangen, Faculty of Medicine, Friedrich-Alexander-University of Erlangen-Nuremberg, Erlangen, Germany
| | - Andreas Moritz
- Department of Anesthesiology, University Hospital Erlangen, Faculty of Medicine, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen, Germany
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Eldawlatly AA, Basheer MK, AlHamdi MA, El-Tahan MR. Expert opinion on the use of fiberoptic bronchospe to check the insertion depth of the left-sided double-lumen tube. Saudi J Anaesth 2024; 18:272-275. [PMID: 38654857 PMCID: PMC11033895 DOI: 10.4103/sja.sja_698_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 08/15/2023] [Accepted: 08/16/2023] [Indexed: 04/26/2024] Open
Abstract
Left-sided double-lumen tube (LDLT) is commonly used to achieve one lung isolation in most thoracic surgical procedures. Traditionally, the LDLT is blindly placed using direct or video laryngoscopy. In this brief report, we highlight the importance of using our novel insertion depth formula to predict the appropriate LDLT insertion depth and demonstrate the current evidence supporting the efficacy of the formula. Also, we will discuss two relatively new devices of LDLTs: one with an embedded camera at the distal end of the tracheal lumen and the other with a carinal cuff between the bronchial cuff and the tracheal lumen in reducing the incidence of too deep inserted LDLT. We advocate that using our novel formula and these two new devices may reduce but not eliminate the need for FOB to check the insertion depth of LDLT.
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Affiliation(s)
- Abdelazeem A. Eldawlatly
- Department of Anesthesia, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Musaab K. Basheer
- Department of Anesthesia, King Abdullah Medical City, Makkah, Kingdom of Saudi Arabia
| | - Malik A. AlHamdi
- Department of Anesthesia, King Saud University Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Mohamed R. El-Tahan
- Department of Anesthesia, Imam Abulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
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Shui W, Hu W, Ma W, Han Y, Hao IY, Zhu S, Sun Y, Deng Z, Gao Y, Heng L, Zhu S. The effects of video double-lumen tubes on intubation complications in patients undergoing thoracic surgery: A randomised controlled study. Eur J Anaesthesiol 2024; 41:305-313. [PMID: 38298060 PMCID: PMC10906194 DOI: 10.1097/eja.0000000000001959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
BACKGROUND Tracheal injuries, vocal cord injuries, sore throat and hoarseness are common complications of double-lumen tube (DLT) intubation. OBJECTIVE This study aimed to evaluate the effects of 'video double-lumen tubes' (VDLTs) on intubation complications in patients undergoing thoracic surgery. DESIGN A randomised controlled study. SETTINGT Xuzhou Cancer Hospital, Xuzhou, China, from January 2023 to June 2023. PATIENTS One hundred eighty-two patients undergoing elective thoracic surgery with one-lung ventilation were randomised into two groups: 90 in the DLT group and 92 in the VDLT group. INTERVENTION VDLT was selected for intubation in the VDLT group, and DLT was selected for intubation in the DLT group. A fibreoptic bronchoscope (FOB) was used to record tracheal and vocal cord injuries. MAIN OUTCOME MEASURES The primary outcomes were the incidence of moderate-to-severe tracheal injury and the incidence of vocal cord injury. The secondary outcomes included the incidence and severity of postoperative 24 and 48 h sore throat and hoarseness. RESULTS The incidence of moderate-to-severe tracheal injury was 32/90 (35.6%) in the DLT group, and 45/92 (48.9%) in the VDLT group ( P = 0.077; relative risk 1.38, 95% CI, 0.97 to 1.95). The incidence of vocal cord injury was 31/90 (34.4%) and 34/92 (37%) in the DLT and VDLT groups, respectively ( P = 0.449). The incidence of postoperative 24 h sore throat and hoarseness was significantly higher in the VDLT group than in the DLT group (for sore throat: P = 0.032, relative risk 1.63, 95% CI, 1.03 to 2.57; for hoarseness: P = 0.018, relative risk 1.48, 95% CI, 1.06 to 2.06). CONCLUSION There was no statistically significant difference in the incidence of moderate-to-severe tracheal injury and vocal cord injury between DLTs and VDLTs. While improving the first-attempt success rate, intubation with VDLT increased the incidence of postoperative 24 h sore throat and hoarseness. TRIAL REGISTRATION Chinese Clinical Trial Registry identifier: ChiCTR2300067348.
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Affiliation(s)
- Weikang Shui
- From the Jiangsu Province Key laboratory of Anaesthesiology, Xuzhou Medical University (WS, WH, YS, ZD, SZ), Department of Anaesthesiology, Xuzhou Cancer Hospital, Xuzhou (WM, YH, SZ, LH, SZ), California State University, Los Angeles, USA (IYH) and Jiangsu University, Zhenjiang, Jiangsu, China (YG)
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Tao D, Zhang G, Zheng X, Wang X, Gao G, Yang Z, Lin Y, Lu L. Feasibility study of intubation in lateral position using Viva-sight double-lumen tube combined with video laryngoscope in patients undergoing pulmonary lobectomy. Asian J Surg 2024; 47:373-379. [PMID: 37696694 DOI: 10.1016/j.asjsur.2023.08.199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/23/2023] [Accepted: 08/30/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Double-lumen tube (DLT) intubation in lateral decubitus position is rarely reported. We designed this study to evaluate the feasibility of VivaSight double-lumen tube (VDLT) intubation assisted by video laryngoscope in lateral decubitus patients. METHODS Patients undergoing elective video-assisted thoracoscopic surgery (VATS) for lung lobectomy were assessed for eligibility between January 2022 and December, 2022. Eligible patients were randomly allocated into supine intubation group (group S) and lateral intubation group (group L) by a computer-generated table of random numbers. The prime objective was to observe whether the success rate of VDLT intubation in lateral position with the aid of video laryngoscope was not inferior to that in supine position. RESULTS A total of 116 patients were assessed, and 88 eligible patients were randomly divided into group L (n = 44) and group S (n = 44). The success rate of the first attempt intubation in the L group was 90.5%, lower than that of S group (97.7%), but there was no statistical difference (p > 0.05). Patients in both groups were intubated with VDLT for no more than 2 attempts. The mean intubation time was 91.98 ± 26.70 s in L group, and 81.39 ± 34.35 s in S group (p > 0.05). The incidence of the capsular malposition in the group L was 4.8%, less than 36.4% of group S (p < 0.001). After 24 h of follow-up, it showed a higher incidence of sore throat in group S, compared to that in group L (p = 0.009). CONCLUSION Our study shows the comprehensive success rate of intubation in lateral decubitus position with VDLT assisted by video laryngoscope is not inferior to that in supine position, with less risk of intraoperative tube malposition and postoperative sore throat. TRIAL REGISTRATION Chinese Clinical Trail Register (ChiCTR2200062989).
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Affiliation(s)
- Deqiang Tao
- Department of Anesthesiology, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, China
| | - Guyue Zhang
- Department of Anesthesiology, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, China
| | - Xiangli Zheng
- Department of Anesthesiology, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, China
| | - Xiaofan Wang
- Department of Anesthesiology, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, China
| | - Guangya Gao
- Department of Anesthesiology, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, China
| | - Zhanmin Yang
- Department of Anesthesiology, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, China
| | - Yanjun Lin
- Department of Anesthesiology, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, China.
| | - Liangyuan Lu
- Department of Anesthesiology, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, China.
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Panidapu N, Lakshmi MB, Madathil T, Micka R, Varma PK, Neema PK. Fluoroscopy-Guided positioning of the bronchial blocker. Ann Card Anaesth 2023; 26:474-475. [PMID: 37861593 PMCID: PMC10691565 DOI: 10.4103/aca.aca_63_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/05/2023] [Accepted: 05/15/2023] [Indexed: 10/21/2023] Open
Affiliation(s)
- Nagarjuna Panidapu
- Department of Cardiac Anaesthesiology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - M Bhakya Lakshmi
- Department of Cardiac Anaesthesiology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Thushara Madathil
- Department of Cardiac Anaesthesiology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Rohik Micka
- Department of Cardiovascular and Thoracic Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Praveen K. Varma
- Department of Cardiovascular and Thoracic Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Praveen K. Neema
- Department of Cardiac Anaesthesiology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
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Grünewald M, Ocampos T, Rogge D, Egberts JH. [Video-assisted Double-lumen Tubes in Robot-assisted Oesophageal Surgery]. Anasthesiol Intensivmed Notfallmed Schmerzther 2023; 58:246-252. [PMID: 37044108 DOI: 10.1055/a-1490-5287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
Robot-assisted esophagectomies are still considered high-risk procedures requiring complex surgical and anesthesiological planning and coordination. The operative space during the thoracic operative part is created by one-lung ventilation. Due to special patient positioning and intraoperative repositioning maneuvers, however, access to patient airway or double-lumen tube manipulation, if necessary, is only possible to a certain extent. In this work, we present our experiences establishing a video-guided double-lumen tube for esophageal surgery. From our point of view, the use of video-guided double-lumen tubes is very suitable increasing patient safety and coordination in the operational team during esophagectomy.
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Wang PK, Lin TY, Su IM, Chang KV, Wu WT, Özçakar L. Preoperative lung ultrasound for confirming the double-lumen endotracheal tube position for one-lung ventilation: A systematic review and meta-analysis. Heliyon 2023; 9:e15458. [PMID: 37128322 PMCID: PMC10147981 DOI: 10.1016/j.heliyon.2023.e15458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 04/03/2023] [Accepted: 04/10/2023] [Indexed: 05/03/2023] Open
Abstract
Objectives Insertion of a double-lumen endotracheal tube (DLT) is the most commonly used method for one-lung ventilation (OLV). This meta-analysis was aimed at investigating the performance of lung ultrasound in assessing the DLT position in OLV. Methods Electronic databases were searched for related trials from inception to October 2022. The primary outcome was the performance of ultrasound or clinical evaluation in confirming the correctness of the DLT position, using fiberoptic bronchoscopy or intraoperative direct visualization of lung collapse as the gold standard. The secondary outcome was the time required to confirm or adjust the DTL position. Results Five randomized controlled trials and three observational studies involving 771 patients were included in the meta-analysis. The pooled sensitivity and specificity of ultrasound were 0.93 (95% confidence interval [CI]: 0.79-0.98) and 0.61 (95% CI: 0.41-0.77), respectively, while those of clinical evaluation were 0.93 (95% CI: 0.73-0.99) and 0.35 (95% CI: 0.25-0.47), respectively. The pooled procedure duration was 122.27 s (95% CI: 20.85-223.69) with ultrasound and 112.03 s (95% CI: 95.30-128.76) with clinical evaluation. The area under the curve for discriminating the DLT position was 0.86 (95% CI: 0.82-0.88) for ultrasound and 0.52 (95% CI: 0.48-0.57) for clinical evaluation. Conclusions Compared to clinical evaluation, ultrasound has a similar sensitivity but a better specificity for confirming the correctness of the DLT position. Ultrasound is an acceptable imaging tool for assessing DTL placement in OLV.
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Affiliation(s)
- Po-Kai Wang
- Department of Anesthesiology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan; School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Ting-Yu Lin
- Department of Physical Medicine and Rehabilitation, Lo-Hsu Medical Foundation, Inc., Lotung Poh-Ai Hospital, Yilan City, Taiwan
| | - I-Min Su
- Department of Anesthesiology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan; School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Ke-Vin Chang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, National Taiwan University College of Medicine, Taipei, Taiwan
- Center for Regional Anesthesia and Pain Medicine, Wang-Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Corresponding author. Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch and National Taiwan University College of Medicine, Taipei, Taiwan.
| | - Wei-Ting Wu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
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Wang W, Gong Z, Zhao M, Zhang Z, Qiu Y, Jiang Q, Wu J. Hypoxemia in thoracoscopic lung resection surgery using a video double-lumen tube versus a conventional double-lumen tube: A propensity score-matched analysis. Front Surg 2023; 10:1090233. [PMID: 36874459 PMCID: PMC9982010 DOI: 10.3389/fsurg.2023.1090233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 01/16/2023] [Indexed: 02/19/2023] Open
Abstract
Background Malposition of the double-lumen tubes (DLTs) may lead to hypoxemia during one-lung ventilation (OLV). Video double-lumen tubes (VDLTs) enable continuous observation of DLT position and avoid displacement. We aimed to investigate whether VDLTs could reduce the incidence of hypoxemia during OLV compared with conventional double-lumen tubes (cDLT) in thoracoscopic lung resection surgery. Methods This was a retrospective cohort study. Adult patients who underwent elective thoracoscopic lung resection surgery and required VDLTs or cDLTs for OLV at Shanghai Chest Hospital from January 2019 to May 2021 were included. The primary outcome was the incidence of hypoxemia during OLV between VDLT and cDLT. Secondary outcomes included bronchoscopy use, the degree of PaO2 decline, and arterial blood gas indices. Results A total of 1,780 patients were finally analyzed in propensity score-matched cohorts (VDLT vs. cDLT 1:1 n = 890). The incidence of hypoxemia decreased from 6.5% (58/890) in cDLT group to 3.6% (32/890) in VDLT group (Relative Risk [RR]: 1.812, 95% CI: 1.19-2.76, p = 0.005). The use of bronchoscopy was reduced by 90% in VDLT group (VDLT 10.0% (89/890) vs. cDLT 100% (890/890), p < 0.001). PaO2 after OLV was 221 [136.0-325.0] mmHg in cDLT group compared to 234 [159.7-336.2] mmHg in VDLT group, p = 0.003. The percentage of PaO2 decline was 41.4 [15.4-61.9] % in cDLT group, while it was 37.7 [8.7-55.9] % in the VDLT group, p < 0.001. In patients who suffered from hypoxemia, there were no significant differences in arterial blood gas indices or the percentage of PaO2 decline. Conclusion VDLTs reduce the incidence of hypoxemia and the use of bronchoscopy during OLV compared with cDLTs. VDLT may be a feasible option for thoracoscopic surgery.
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Affiliation(s)
- Wei Wang
- Department of Anesthesiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Zhihao Gong
- Department of Anesthesiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Mingye Zhao
- Department of Anesthesiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Zuojing Zhang
- Department of Anesthesiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Yuwei Qiu
- Department of Anesthesiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Qiliang Jiang
- Department of Anesthesiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Jingxiang Wu
- Department of Anesthesiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
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Zhang X, Wang DX, Wei JQ, Liu H, Hu SP. Recent advances in double-lumen tube malposition in thoracic surgery: A bibliometric analysis and narrative literature review. Front Med (Lausanne) 2022; 9:1071254. [PMID: 36590949 PMCID: PMC9795184 DOI: 10.3389/fmed.2022.1071254] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 11/21/2022] [Indexed: 12/15/2022] Open
Abstract
Thoracic surgery has increased drastically in recent years, especially in light of the severe outbreak of the 2019 novel coronavirus disease (COVID-19). Routine "passive" chest computed tomography (CT) screening of inpatients detects some pulmonary diseases requiring thoracic surgeries timely. As an essential device for thoracic anesthesia, the double-lumen tube (DLT) is particularly important for anesthesia and surgery. With the continuous upgrading of the DLTs and the widespread use of fiberoptic bronchoscopy (FOB), the position of DLT in thoracic surgery is gradually becoming more stable and easier to observe or adjust. However, DLT malposition still occurs during transferring patients from a supine to the lateral position in thoracic surgery, which leads to lung isolation failure and hypoxemia during one-lung ventilation (OLV). Recently, some innovative DLTs or improved intervention methods have shown good results in reducing the incidence of DLT malposition. This review aims to summarize the recent studies of the incidence of left-sided DLT malposition, the reasons and effects of malposition, and summarize current methods for reducing DLT malposition and prospects for possible approaches. Meanwhile, we use bibliometric analysis to summarize the research trends and hot spots of the DLT research.
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Affiliation(s)
- Xi Zhang
- Department of Anesthesiology, Huzhou Central Hospital, The Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Affiliated Central Hospital of Huzhou University, Huzhou, China,Department of Anesthesiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Huzhou, China
| | - Dong-Xu Wang
- Department of Anesthesiology, Huzhou Central Hospital, The Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Affiliated Central Hospital of Huzhou University, Huzhou, China
| | - Jing-Qiu Wei
- Department of Education and Training, Huzhou Central Hospital, The Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Affiliated Central Hospital of Huzhou University, Huzhou, China
| | - He Liu
- Department of Anesthesiology, Huzhou Central Hospital, The Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Affiliated Central Hospital of Huzhou University, Huzhou, China,He Liu
| | - Si-Ping Hu
- Department of Anesthesiology, Huzhou Central Hospital, The Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Affiliated Central Hospital of Huzhou University, Huzhou, China,*Correspondence: Si-Ping Hu
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Effect of Sufentanil Combined with Nalmefene Assisted Surface Anesthesia on Transnasal Endotracheal Intubation Guided by Fiberoptic Bronchoscope. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:5144875. [PMID: 36134115 PMCID: PMC9481346 DOI: 10.1155/2022/5144875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 08/19/2022] [Accepted: 08/30/2022] [Indexed: 11/18/2022]
Abstract
In order to study the clinical effect of sufentanil combined with nalmefene in fiberoptic bronchoscopy tracheal intubation in airway patients, a method based on sufentanil combined with nalmefene-assisted topical anesthesia for fiberoptic bronchoscopy-guided nasotracheal intubation method is proposed. This method retrospectively analyzed 100 patients with difficult airways who underwent fiberoptic bronchoscope tracheal intubation in the Central Hospital from January 2021 to November 2021. The analysis results showed that compared with the control group, the patients in the study group had a significantly lower cough score, a higher Ramsay sedation score, a lower mean arterial pressure, and a lower number of patients with hypoxia (P < 0.05). There was no significant difference in postoperative hoarseness and sore throat between the two groups. Sufentanil combined with nalmefene has a better anesthesia effect and higher safety for bronchofiberscope intubation in patients with difficult airways.
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沈 诚, 梁 鹏, 车 国. [Application and Research Progress of Video Double-lumen Tube in Thoracic Surgery]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2022; 25:622-626. [PMID: 36002200 PMCID: PMC9411952 DOI: 10.3779/j.issn.1009-3419.2022.101.35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 05/20/2022] [Accepted: 05/22/2022] [Indexed: 11/09/2022]
Abstract
The rapid development and promotion of minimally invasive thoracic surgery represented by video-assisted thoracoscopy surgery has gradually replaced traditional thoracic surgery technique as the primary choice for the treatment of pulmonary nodules, including early lung cancer. With the clinical application of double-lumen bronchial catheters, the realization of one-lung ventilation technology not only provides a solid anesthesia foundation for the popularization of minimally invasive thoracic surgery, but also provides a guarantee for the rapid and smooth implementation of the operation. However, compared with single-lumen bronchial catheters, the diameter of the double-lumen bronchial catheter is thicker, and the tube body is hard and difficult to shape, which brings inconvenience to anesthesia intubation. The bronchial structure is different, and the incidence of dislocation during anesthesia intubation is also high. With the gradual clinical use of video double-lumen tube (VDLT), it has become a hot spot in thoracic surgery in recent years. This article reviews the application and research progress of VDLT in thoracic surgery.
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Affiliation(s)
- 诚 沈
- 610041 成都,四川大学华西医院胸外科Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 鹏 梁
- 610041 成都,四川大学华西医院麻醉科Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 国卫 车
- 610041 成都,四川大学华西医院胸外科Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
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Karczewska K, Bialka S, Smereka J, Cyran M, Nowak-Starz G, Chmielewski J, Pruc M, Wieczorek P, Peacock FW, Ladny JR, Szarpak L. Efficacy and Safety of Video-Laryngoscopy versus Direct Laryngoscopy for Double-Lumen Endotracheal Intubation: A Systematic Review and Meta-Analysis. J Clin Med 2021; 10:jcm10235524. [PMID: 34884226 PMCID: PMC8658072 DOI: 10.3390/jcm10235524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 11/22/2021] [Accepted: 11/24/2021] [Indexed: 11/24/2022] Open
Abstract
The available meta-analyses have inconclusively indicated the advantages of video-laryngoscopy (VL) in different clinical situations; therefore, we conducted a systematic review and meta-analysis to determine efficacy outcomes such as successful first attempt or time to perform endotracheal intubation as well as adverse events of VL vs. direct laryngoscopes (DL) for double-lumen intubation. First intubation attempt success rate was 87.9% for VL and 84.5% for DL (OR = 1.64; 95% CI: 0.95 to 2.86; I2 = 61%; p = 0.08). Overall success rate was 99.8% for VL and 98.8% for DL, respectively (OR = 3.89; 95%CI: 0.95 to 15.93; I2 = 0; p = 0.06). Intubation time for VL was 43.4 ± 30.4 s compared to 54.0 ± 56.3 s for DL (MD = −11.87; 95%CI: −17.06 to −6.68; I2 = 99%; p < 0.001). Glottic view based on Cormack–Lehane grades 1 or 2 equaled 93.1% and 88.1% in the VL and DL groups, respectively (OR = 3.33; 95% CI: 1.18 to 9.41; I2 = 63%; p = 0.02). External laryngeal manipulation was needed in 18.4% cases of VL compared with 42.8% for DL (OR = 0.28; 95% CI: 0.20 to 0.40; I2 = 69%; p < 0.001). For double-lumen intubation, VL offers shorter intubation time, better glottic view based on Cormack–Lehane grade, and a lower need for ELM, but comparable first intubation attempt success rate and overall intubation success rate compared with DL.
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Affiliation(s)
- Katarzyna Karczewska
- Department of Anesthesiology, Masovian Specialist Hospital, 26-617 Radom, Poland;
| | - Szymon Bialka
- Department of Anesthesiology and Intensive Care, Medical University of Silesia, 41-800 Zabrze, Poland;
| | - Jacek Smereka
- Department of Emergency Medical Service, Wroclaw Medical University, 51-618 Wroclaw, Poland;
- Research Unit, Polish Society of Disaster Medicine, 05-806 Warszawa, Poland; (M.C.); (M.P.); (P.W.)
| | - Maciej Cyran
- Research Unit, Polish Society of Disaster Medicine, 05-806 Warszawa, Poland; (M.C.); (M.P.); (P.W.)
- Institute of Outcomes Research, Maria Sklodowska-Curie Medical Academy, 03-411 Warsaw, Poland
| | - Grazyna Nowak-Starz
- Institute of Health Sciences, Jan Kochanowski University of Kielce, 25-369 Kielce, Poland;
| | | | - Michal Pruc
- Research Unit, Polish Society of Disaster Medicine, 05-806 Warszawa, Poland; (M.C.); (M.P.); (P.W.)
| | - Pawel Wieczorek
- Research Unit, Polish Society of Disaster Medicine, 05-806 Warszawa, Poland; (M.C.); (M.P.); (P.W.)
- Research Unit, Polonia University, 42-200 Czestochowa, Poland
| | - Frank William Peacock
- Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine, Houston, TX 77030, USA;
| | - Jerzy Robert Ladny
- Department of Emergency Medicine, Bialystok Medical University, 15-295 Bialystok, Poland;
| | - Lukasz Szarpak
- Research Unit, Polish Society of Disaster Medicine, 05-806 Warszawa, Poland; (M.C.); (M.P.); (P.W.)
- Research Unit, Maria Sklodowska-Curie Bialystok Oncology Center, 15-027 Bialystok, Poland
- Correspondence: ; Tel.: +48-500-186-225
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