An original backup technique to assess the correct positioning of right-sided double-lumen tubes without fiberoptic bronchoscopy: A pilot feasibility study.

BACKGROUND

Accurate positioning of a right-sided double-lumen tube is essential but challenging due to the location and the potential obstruction of the right upper lobe bronchus. Fiberoptic bronchoscopy is, therefore, necessary but requires a specific training period for the anesthesiologist and might not always be available.

OBJECTIVE

We describe an original backup technique to assess the correct placement of these tubes in cases a fiberopetic bronchoscopy is lacking.

DESIGN

Prospective pilot feasibility study with 10 adult patients scheduled for a left thoracic surgery.

SETTING

Operating theater in a universitary hospital.

MATERIALS AND

METHODS

The new technique uses a fluoroscopy and an adult central venous catheter wire. The time needed to perform the new technique, its success rate and its efficacy in properly exclude the left lung were evaluated. Any oxygen desaturation episode (SpO2 <90%) was considered. The technique was performed by two anesthesiologists with different experience in thoracic anesthesia.

RESULTS

The success rate of our technique was 90%, which did not depend on the anesthesiologist's experience. The range of time to successfully place the tube in the dorsal decubitus position and subsequently in the right lateral decubitus position was respectively 1 min-6 min and 1 min-15 min. None of the patients presented any desaturation episodes.

CONCLUSIONS

We describe an original, safe, and acceptable backup technique to properly insert right-sided double-lumen endobronchial tubes, whenever a fiberoptic bronchoscopy is not available. Moreover, this technique is easy enough to be performed by anesthesiologists with limited experience in thoracic anesthesia.