Insertion of the double lumen tube in the difficult airway*

Abstract

Summary Isolation of a lung and one‐lung ventilation are commonly used during thoracic surgery. Insertion of double lumen tubes requires considerable skill and may be especially challenging in the difficult airway. We describe a method of inserting double lumen tubes in two patients with known difficult airways. This technique involves awake nasotracheal intubation followed by insertion of an oral double lumen tube under general anaesthesia.

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

“…Double‐lumen tubes are produced in left‐ and right‐sided designs, and correct placement is critical to ensure proper functioning and ventilation . Placement of a double‐lumen tube can be challenging, because the view through a laryngoscope is frequently obstructed by the tube itself, due to its fixed shape, large diameter and long length . The traditional approach to placement of a left‐sided double‐lumen tube is to place the tip of the tube through the larynx under direct vision, rotate the tube 90° counter‐clockwise and then blindly advance the tube into the left main stem bronchus to a depth of 27–29 cm, using the teeth as a reference .…”

An unusual way of lung isolation performed using a bronchial blocker passed via partially resected larynx for thoracoscopic esophagectomy

“…A bronchial blocker can be quickly inserted through a single-lumen tube, which is technically easier than DLT. [ 1 2 3 ] The smaller profile of a single-lumen tube makes surgical dissection of the airway and esophagus easier and safer during thoracic esophagectomy. [ 4 ] A bronchial blocker avoids postoperative ETT exchange if postoperative ventilation is planned.…”

‘Fibreoptic in Tracheal Lumen’ (FIT) technique: A novel real-time double-lumen tube placement technique with fiberoptic bronchoscope

“…This may be due to its preformed shape, large diameter, and extra length. [23] Conventionally, two techniques are commonly used for placement of DLT; blind technique and other fiberoptic bronchoscope (FOB) guided.…”