A randomised trial comparing real-time double-lumen endobronchial tube placement with the Disposcope® with conventional blind placement

Anaesthesia. 2017 Sep;72(9):1097-1106. doi: 10.1111/anae.13984.

Abstract

Double-lumen endobronchial tube placement is challenging. This study compared double-lumen tube placement with the Disposcope® , a wireless videostylet allowing real-time visualisation, with conventional blind placement. Patients undergoing elective thoracic surgery with normal airways requiring one-lung ventilation were randomly allocated into two groups (27 patients in each group). The Disposcope was used to assist left-sided double-lumen tube placement in one group, and conventional blind placement was performed in the control group. Placement in both groups was checked with fibreoptic bronchoscopy. The Disposcope-assisted group had a shorter total mean (SD) placement time (18.6 (2.5) s vs. 21.4 (2.9) s, p < 0.001), laryngoscopy to end of auscultation time (83.4 (3.0) s vs. 93.9 (5.7) s, p < 0.001) and total operation time (130.7 (6.1) s vs. 154.5 (6.3) s, p < 0.001). In the Disposcope-assisted group, the double-lumen tube was inserted in the correct side in all patients (100.0%), whereas in the conventional group, the double-lumen tube was placed in the correct side in 25 (92.6%) patients and in the wrong side in 2 (7.4%) patients; the difference was not significant (p = 0.150). In the Disposcope-assisted group, the double-lumen tube was inserted to the optimal depth in 24 (88.9%) patients, whereas in the conventional group it was inserted to the optimal depth in one (4.0%) patient. The Disposcope increased the success rate of double-lumen tube placement, and shortened the total operation time when compared with standard placement with confirmation using fibreoptic bronchoscopy, and may replace the conventional method.

Keywords: chest surgery; double-lumen endobronchial tube; fibreoptic; videostylet.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Aged
  • Anesthesia, General
  • Auscultation
  • Bronchoscopes*
  • Bronchoscopy / methods*
  • Female
  • Fiber Optic Technology
  • Humans
  • Intubation, Intratracheal / instrumentation*
  • Intubation, Intratracheal / methods
  • Laryngoscopy
  • Male
  • Middle Aged
  • One-Lung Ventilation
  • Operative Time
  • Thoracic Surgical Procedures