The effects of thermal softening of double-lumen endobronchial tubes on postoperative sore throat, hoarseness and vocal cord injuries: a prospective double-blind randomized trial

Seo, Jeonghwa; Cho, C. W.; Hong, Deok Man; Jeon, Yunseok; Bahk, Jae Hyon

doi:10.1093/bja/aev414

Cited by 66 publications

(72 citation statements)

References 34 publications

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“…In addition, when a R-DLT is inserted into a patient’s airway, body heat may decrease the stiffness of the DLT. In a previous study, warming the distal part of the DLT appeared to be effective for reducing some airway complications [ 16 , 17 ] . A previous study reported that 3% of the patients were hoarse for more than 5 postoperative days [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

A method for addressing right upper lobe obstruction with right-sided double-lumen endobronchial tubes during surgery: a randomized controlled trial

Wang

Gao

et al. 2018

BMC Anesthesiol

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BackgroundA right-sided double-lumen tube (R-DLT) tends to obstruct the right upper lobe intraoperatively due to anatomical distortion during surgery. If the R-DLT is poorly matched with the patient’s airway anatomy, it will not be possible to correctly replace the tube with a fiberoptic bronchoscope (FOB). In our study, we aimed to explore an efficient method for difficult repositioning caused by right upper lobe occlusion during surgery: repositioning the R-DLT from the right main bronchus into the left main bronchus. The current study was designed to assess the efficacy and safety of this method.MethodsSixty adult patients scheduled to undergo left-sided thoracic surgery were randomly assigned to two groups. With the patient in the right lateral position during surgery, the R-DLT was pulled back to the trachea while being rotated 90° clockwise; it was then either rotated 90° clockwise for placement into the left main bronchus (Group L) or rotated 90° anticlockwise and returned to the right main bronchus (Group R) using FOB guidance. The primary outcomes included clinical performance, which was measured by intubation time, and the quality of lung collapse. A secondary outcome was safety, which was determined according to bronchial injury and vocal cord injury.ResultsThe median intubation time (IQR [range]) required for placement of a R-DLT into the left main bronchus was shorter than the time required for placement into the right main bronchus (15.0 s [IQR, 12.0 to 20.0 s]) vs 23.5 s [IQR, 14.5 to 65.8 s], P = 0.005). The groups showed comparable overall results for the quality of lung collapse during the total period of one-lung ventilation (P = 1.000). The numbers of patients with bronchial injuries or vocal cord injuries were also comparable between groups (Group R, 11/30 vs. Group L 8/30, P = 0.580 for bronchus injuries; Group R, 15/30 vs. Group L 13/30, P = 0.796 for vocal cord injuries).ConclusionsRepositioning a R-DLT from the right main bronchus into the left main bronchus had good clinical performance without causing additional injury. This may be an efficient method for the difficult repositioning of a R-DLT due to right upper lobe occlusion during surgery.Trial registrationChinese Clinical Trial Registry, ChiCTR-IPR-15006933, registered on 15 August 2015.Electronic supplementary materialThe online version of this article (10.1186/s12871-018-0596-3) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

A method for addressing right upper lobe obstruction with right-sided double-lumen endobronchial tubes during surgery: a randomized controlled trial

Wang

Gao

et al. 2018

BMC Anesthesiol

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“…Exclusion criteria were the presence of intraluminal surgical lesions in the left or right bronchus, anatomic anomalies in the tracheobronchial tree such as tracheomalacia or tracheal bronchus, expected difficult airway (neck extension <35 • , mandibular-hyoid distance <6.0 cm, and sternomental distance <12.5 cm), a body mass index >30 kg/m 2 , upper respiratory infection, a history of thoracic surgery, any blood coagulation disorder, and the requirement of an emergency operation. is also more likely to result in airway injury, probably because DLT is stiffer, has a larger external diameter, and is inserted deeply into the mainstem bronchus [7]. A novel triple-cuffed ANKOR DLT (Insung Medical, Wonjou, Republic of Korea) was recently developed to facilitate proper DLT positioning via the addition of a carinal cuff between the bronchial cuff and the tracheal lumen [8].…”

Section: Study Populationmentioning

confidence: 99%

“…However, previous studies report malpositioning requiring subsequent repositioning in approximately 35% to 48% of DLT procedures, even when they are conducted by experienced clinicians [4][5][6]. Endobronchial intubation with a DLT is also more likely to result in 2 of 9 airway injury, probably because DLT is stiffer, has a larger external diameter, and is inserted deeply into the mainstem bronchus [7].…”

Section: Introductionmentioning

confidence: 99%

A Randomized Controlled Trial Comparing Novel Triple-Cuffed Double-Lumen Endobronchial Tubes with Conventional Double-Lumen Endobronchial Tubes for Lung Isolation

Kim

Byon

Kim

et al. 2020

JCM

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Placing a double-lumen endobronchial tube (DLT) in an appropriate position to facilitate lung isolation is essential for thoracic procedures. The novel ANKOR DLT is a DLT developed with three cuffs with a newly added carinal cuff designed to prevent further advancement by being blocked by the carina when the cuff is inflated. In this prospective study, the direction and depth of initial placement of ANKOR DLT were compared with those of conventional DLT. Patients undergoing thoracic surgery (n = 190) with one-lung ventilation (OLV) were randomly allocated into either left-sided conventional DLT group (n = 95) or left-sided ANKOR DLT group (n = 95). The direction and depth of DLT position were compared via fiberoptic bronchoscopy (FOB) after endobronchial intubation between the groups. There was no significant difference in the number of right mainstem endobronchial intubations between the two groups (p = 0.468). The difference between the initial depth of DLT placement and the target depth confirmed by FOB was significantly lower in the ANKOR DLT group than in the conventional DLT group (1.8 ± 1.8 vs. 12.9 ± 9.7 mm; p < 0.001). In conclusion, the ANKOR DLT facilitated its initial positioning at the optimal depth compared to the conventional DLT.

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“…Sore throat is common after tracheal intubation [ 1 – 21 ]. Various drugs [ 7 , 9 , 12 , 13 , 15 , 16 , 19 ] or lubricants [ 5 , 10 , 14 , 17 , 18 ] have been introduced to reduce the sore throat although some methods seem to be applied without evidence.…”

Section: Introductionmentioning

confidence: 99%

Tracheal tubes lubricated with water to reduce sore throat after intubation: A randomized non-inferiority trial

et al. 2018

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BackgroundSore throat is common after tracheal intubation. Water can be used to lubricate tracheal tubes, but its benefit has not been validated. We thus did a randomised non-inferiority trial to test the hypothesis that a tube lubricated with water does not reduce sore throat after tracheal intubation.MethodsWe randomized female or male patients (n = 296) undergoing surgery in the ears or eyes to receive either a tube lubricated with water or a tube without lubrication for intubation. We assessed sore throat at 0, 2, 4, and 24 h after surgery; pharyngeal injury at 2 and 24 h after surgery; and respiratory infections within 7 days after surgery. For the incidence of sore throat within 24 h after surgery (primary outcome), the two-sided 90% confidence interval of the risk difference was compared with the prespecified non-inferiority margin of 15%. Other outcomes were analyzed with two-sided superiority tests.ResultsThe incidence of sore throat within 24 h after surgery was 80/147 (54.4%) in the non-lubricated tube group and 83/149 (55.7%) in the water-lubricated tube group (risk difference -1.3%, 90% confidence interval -10.9% to 8.3%). Because the confidence interval was below the non-inferiority margin, the incidence of sore throat was not higher in the non-lubricated tube group than in the water-lubricated tube group. There was no significant association between groups in the sore throat, pharyngeal injury, and respiratory infection at each assessment time.ConclusionsThe tube lubricated with water did not reduce sore throat and pharyngeal injury after tracheal intubation compared to the tube without lubrication.

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The effects of thermal softening of double-lumen endobronchial tubes on postoperative sore throat, hoarseness and vocal cord injuries: a prospective double-blind randomized trial

Abstract: NCT 01626365.

Cited by 66 publications

References 34 publications

A method for addressing right upper lobe obstruction with right-sided double-lumen endobronchial tubes during surgery: a randomized controlled trial

A method for addressing right upper lobe obstruction with right-sided double-lumen endobronchial tubes during surgery: a randomized controlled trial

A Randomized Controlled Trial Comparing Novel Triple-Cuffed Double-Lumen Endobronchial Tubes with Conventional Double-Lumen Endobronchial Tubes for Lung Isolation

Tracheal tubes lubricated with water to reduce sore throat after intubation: A randomized non-inferiority trial

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