1
|
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.
Collapse
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
| |
Collapse
|
2
|
Shah SB, Hariharan U, Chawla R. Choosing the correct-sized adult double-lumen tube: Quest for the holy grail. Ann Card Anaesth 2023; 26:124-132. [PMID: 37706375 PMCID: PMC10284481 DOI: 10.4103/aca.aca_140_22] [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: 08/15/2022] [Revised: 10/03/2022] [Accepted: 10/12/2022] [Indexed: 09/15/2023] Open
Abstract
Appropriate size selection of double-lumen tubes (DLTs) for one-lung ventilation (OLV) in adults is still a humongous task. Several important factors are to be considered like patient height, gender, tracheal diameter, left main bronchial diameter, and cricoid cartilage transverse diameter. In addition to radiological assessment of the airway diameters, the manufacturing details of the particular DLT being used also play a significant role in size selection. Optimal positioning of the appropriately sized DLT is indispensable to avoid complications like airway trauma, cuff rupture, hypoxemia, and tube displacement. It is imperative to know whether the one-size-fits-all dictum holds for DLT size selection as claimed by certain studies. Further randomized studies are required for crystallizing standard protocols ascertaining the correct DLT size. This systematic review article highlights the various parameters employed for DLT size selection and explores the newer DLTs used for adult OLV.
Collapse
Affiliation(s)
- Shagun Bhatia Shah
- Department of Anaesthesia and Critical Care, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, New Delhi, India
| | - Uma Hariharan
- Department of Anaesthesiology, Atal Bihari Vajpayee Institute of Medical Sciences and Dr Ram Manohar Lohia Hospital, CHS, New Delhi, India
| | - Rajiv Chawla
- Department of Anaesthesia and Critical Care, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, New Delhi, India
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
Shah SB, Chawla R, Hariharan U, Shukla S. An algorithm for difficult double lumen tube placement and troubleshooting a malpositioned double lumen tube harnessing A, B, Cs of lung isolation. Indian J Anaesth 2022; 66:S328-S332. [PMID: 36425911 PMCID: PMC9680715 DOI: 10.4103/ija.ija_318_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 09/03/2022] [Accepted: 09/09/2022] [Indexed: 11/30/2022] Open
Affiliation(s)
- Shagun Bhatia Shah
- Department of Anaesthesia and Critical Care, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, Delhi, India,Address for correspondence: Dr. Shagun Bhatia Shah, H. No: 174,175 Ground Floor, Pocket 17; Sector 24 Rohini, New Delhi - 110 085, India. E-mail:
| | - Rajiv Chawla
- Department of Anaesthesia and Critical Care, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, Delhi, India
| | - Uma Hariharan
- Department of Anaesthesia and Intensive Care, Dr. Ram Manohar Lohia Hospital and PGIMER, CHS, New Delhi, India
| | - Seema Shukla
- Department of Anaesthesia and Critical Care, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, Delhi, India
| |
Collapse
|
5
|
Boisen ML, Fernando RJ, Kolarczyk L, Teeter E, Schisler T, La Colla L, Melnyk V, Robles C, Rao VK, Gelzinis TA. The Year in Thoracic Anesthesia: Selected Highlights From 2020. J Cardiothorac Vasc Anesth 2021; 35:2855-2868. [PMID: 34053812 DOI: 10.1053/j.jvca.2021.04.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 04/10/2021] [Indexed: 12/20/2022]
Abstract
Selected highlights in thoracic anesthesia in 2020 include updates in the preoperative assessment and prehabilitation of patients undergoing thoracic surgery; updates in one-lung ventilation (OLV) pertaining to the devices used for OLV; the use of dexmedetomidine for lung protection during OLV and protective ventilation, recommendations for the care of thoracic surgical patients with coronavirus disease 2019; a review of recent meta-analyses comparing truncal blocks with paravertebral and thoracic epidural blocks; and a review of outcomes after initiating the enhanced recovery after surgery guidelines for lung and esophageal surgery.
Collapse
Affiliation(s)
- Michael L Boisen
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Rohesh J Fernando
- Cardiothoracic Section, Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC
| | - Lavinia Kolarczyk
- Department of Anesthesiology, University of North Carolina, Chapel Hill, NC
| | - Emily Teeter
- Department of Anesthesiology, University of North Carolina, Chapel Hill, NC
| | - Travis Schisler
- Department of Anesthesiology, Pharmacology, and Therapeutics, University of British Columbia, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Luca La Colla
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Vladyslav Melnyk
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto General Hospital, Toronto, Ontario, Canada
| | - Constantin Robles
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Vidya K Rao
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University, Stanford, CA
| | - Theresa A Gelzinis
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA.
| |
Collapse
|