Abstract
Purpose
To compare a new technique (NT) for positioning the left modified Broncho-Cath™ double-lumen tube (LM-DLT) by fibreoptic bronchoscopy (FOB) to the classic technique (CT).
Methods
Sixty-one adult patients undergoing elective thoracic surgery with LM-DLT were randomly assigned to the NT orto the CT group. For the NT, the endoscopist confirms the left mainstem endobronchial intubation. The proximal edge of the blue bronchial cuff should not be visualized at the carina. Then, through the left bronchial lumen, by transparency across the wall of the tube, the position of the tube is adjusted so that the carina lies midway between the black radiopaque line and the top of the bronchial cuff. After this, the orifice of the left upper lobe (LUL) bronchus should be clearly seen. For the CT, the endoscopist uses the technique described by Benumof and Slinger. After lateral positioning of the patient, the LM-DLT was repositioned if the top of the endobronchial cuff was above the carina or when the LUL bronchus was obstructed.
Results
The incidence of proximal repositioning was significantly less in the NT compared to the CT (16%vs 43%, P=0.007).
Conclusion
Using this new technique, the LM-DLT is inserted deeper in the left mainstem bronchus. This new landmark augments the range of movement that can be tolerated without requiring repositioning of the LM-DLT, This NT to position and to assess LM-DLT, by transparency across the wall of the tube with FOB, is better adapted to the LM-DLT and its recent modifications.
Résumé
Objectif
Comparer une nouvelle technique (NT) de positionnement du tube double-lumière Broncho-Cath™ gauche modifié (TDL-GM), à l’aide de la fibroscopie, à la technique classique (TC).
Méthodes
Soixante et un patients adultes devant subir une chirurgie thoracique programmée avec un TDL-GM ont été randomisés aux groupes NT ou TC. Suivant la NT, l’endoscopiste confirme l’intubation de la bronche souche gauche et le sommet du ballonnet ne doit pas être visualisé juste sous la carène. Par la lumière bronchique, par transparence au travers de la paroi du tube, on ajuste celui-ci pour que la carène se situe à mi-chemin entre la ligne noire radio-opaque et le sommet du ballonnet bronchique. On s’assure également que la bronche lobaire supérieure gauche (LSG) est libre. Suivant la TC, l’endoscopiste utilise la technique décrite par Benumof et Slinger. Après le positionnement en décubitus latéral, le TDL-GM est repositionné lorsque le sommet du ballonnet fait hernie au dessus de la carène ou si la bronche LSG est obstruée.
Résultats
Les repositionnements proximaux sont significativement moins fréquents en utilisant la NT comparativement à la TC (16%vs 43%,P = 0,007).
Conclusion
Lorsqu’on utilise la NT, la partie endobronchique du TDL-GM est insérée plus profondément dans la bronche souche gauche avec de nouveaux points de repère et augmente par conséquent la marge de mouvement qui peut être tolérée sans nécessiter un repositionnement du TDL-GM. Cette NT de positionnement et de vérification, par transparence au travers de la paroi du tube, est mieux adaptée aux modifications récentes du TDL-GM.
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Fortier, G., Coté, D., Bergeron, C. et al. New landmarks improve the positioning of the left Broncho-Cath™ double-lumen tube-comparison with the classic technique. Can J Anesth 48, 790–794 (2001). https://doi.org/10.1007/BF03016696
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DOI: https://doi.org/10.1007/BF03016696