Comparison of the single-lumen endotracheal tube and double-lumen endobronchial tube used in minimally invasive cardiac surgery for the fast track protocol

Abstract

Background: Minimally invasive cardiac surgery (MICS) has been more commonly performed due to the reduced amount of bleeding and transfusion and length of hospital stay. We investigated the feasibility of performing MICS using single-lumen endotracheal tube (SLT). Methods: We conducted a retrospective review of clinical data of 112 patients who underwent MICS between July 2012 and March 2015. The patients underwent MICS using a SLT or a double lumen endotracheal tube (DLT). The duration of intensive care unit (ICU) stay and mechanical ventilation were recorded and analyzed. Results: Of the 96 patients, 50 were intubated with a SLT and 46 were intubated with a DLT. Anesthetic induction to skin incision time, surgical time and total anesthetic time were significant decreased in the SLT group (P<0.05). However, there was no difference in the duration of ICU stay and mechanical ventilation, and the incidence of extubation in operation room between the two groups. Conclusions: Comparing with insertion of a SLT, insertion of a DLT provided equivalent duration of ICU stay and mechanical ventilation after the MICS. Therefore, the type of inserted endotracheal tube would not influence on failure of the fast track protocol and insertion of a SLT is feasible and could be an alternative method to a DLT. that of a single-lumen endotracheal tube (SLT) and may be associated with airway trauma and bleeding (3). Postoperative airway swelling may also occur after using the DLT and the anesthesiologists may be in danger when exchanging a DLT to a SLT at the end of the surgery, even with the use of airway exchange catheters (4). Moreover, there are specific conditions in which a SLT may be preferred to a DLT, such as patients with previous oral or neck surgery who present with a challenging airway and require lung separation. Although one lung ventilation is important but not essential for MICS if it is possible that ventilation can be held or made intermittent both prior to CPB or at its conclusion to permit exposure (5).The cardiothoracic surgeons often consider that complications related with insertion of a DLT would result in failure or interference of the fast track protocol. The goal of this study is to investigate the feasibility of using a SLT compared with a DLT during anesthetic management in MICS and which method of lung deflation is appropriate for the fast tract protocol. MethodsAfter the Institutional Review Board approved, we conducted a retrospective review of clinical data of 112 patients who underwent MICS within about 3-year period beginning in July 2012 at Pusan National University Yangsan Hospital in Yangsan, Republic of Korea.Administering O 2 5 L/min for three minutes after standard monitors were applied to the patient and the anesthesia was induced using propofol (1-2 mg/kg), cisatracurium (0.2 mg/kg), remifentanil. Anesthesia was maintained by sevoflurane and remifentanil and the concentration of sevoflurane was adjusted to maintain the level of bispectral index as 40-60.Trained anesthesiologist inserted a ...

Robotic‐assisted cardiac surgery without lung isolation utilizing single‐lumen endotracheal tube intubation

“…Postoperatively, ventilation time and the lengths of ICU and hospital stay were significantly shorter in the SL group in our study. Kim et al 22 showed no difference in these parameters between patients with SL and DL endotracheal intubation. In most reports on robotic surgery, patients are extubated immediately using the fast track protocol and prolonged intubation is uncommon 2‐11,16,19 .…”

“…Currently, DL endotracheal intubation with lung isolation is the standard for robotic cardiac surgery in high volume robotic cardiac centers 1‐3,10,11,15‐19 . This approach has been applied in video‐assisted cardiothoracic surgery to ensure lung exclusion 20‐26 . However, proper placement of DL endotracheal tubes or bronchial blockers for lung isolation is a complex procedure, requires experienced anesthesiologists and carries potential hazards even in experienced hands 12‐15 .…”

“…Therefore, we may speculate that the potential risks of DL intubation may be minimized with the application of SL intubation and without lung isolation. The feasibility of minimal invasive cardiac operations without lung isolation has been previously used by Kiziltan et al 21 and Kim et al 22 previously. The authors reported no perioperative event that was related to the intubation technique.…”

“…Nevertheless, right‐sided unilateral pulmonary edema developed in several patients. With the goal of providing better outcomes, the studies and alternative techniques in minimally invasive cardiac surgery were reviewed 1‐26 . The literature on robotic cardiac surgery presented no recommendations about the use of SL endotracheal tubes without lung isolation.…”

“…The literature on robotic cardiac surgery presented no recommendations about the use of SL endotracheal tubes without lung isolation. However, some authors used SL endotracheal intubation without lung isolation in minimally invasive cardiac operations 20‐22 . Ito 20 noted that although lung isolation is important but not essential for minimally invasive cardiac surgery.…”