Endobronchial Intubation of Double-lumen Tube: Conventional Method vs Fiberoptic Bronchoscope Guide Method

Summary

Double lumen tube (DLT) needs to be intubated to isolate ventilations of left and right lungs for thoracic surgery. Post-operative sore throat and hoarseness are more frequent with DLT intubation than with single one. Which is may because DLT is relatively thicker, harder, sideway curved and therefore more likely to damage the vocal cord or trachea during intubation, and advanced deeper to the carina and main bronchus level. In the conventional method of intubation, DLT is rotated 90 degrees and advanced blindly to the main bronchus level after DLT is intubated through vocal cord using the direct laryngoscopy. After the blind advancement, the sufficient tube position needs to be gained and confirmed with the fiberoptic bronchoscope. In the bronchoscope guide method, after DLT is intubated through vocal cord using the direct laryngoscopy, the pathway into the targeted main bronchus is secured using the fiberoptic bronchoscope which is passed through a bronchial lumen of DLT. And then DLT can be advanced through the guide of the bronchoscope. In this study, we intend to compare post-operative sore throat, hoarseness and airway injury between the two methods. We hypothesize that the bronchoscope guide method can reduce the post-operative complications and airway injury because surrounding tissues of the airway can be less irritated by DLT intubation in the guide method than in a conventional.

For a constant guide effect, we use fiberoptic bronchoscopes with same outer diameter (4.1 mm) which can pass through a bronchial lumen of 37 and 39 Fr Lt. DLT and cannot pass through 35 Fr or smaller Lt. DLTs.

\<Lt. DLT size selection\>

* male: ≥160 cm, 39 French; \< 160 cm, 37 French
* female: ≥160 cm, 37 French; \< 160 cm, contraindication

Conditions

• Intubation, Intratracheal
• Postoperative Complications
• Sore Throat
• Hoarseness
• Soft Tissue Injuries
• Thoracic Surgery

Interventions

PROCEDURE

Bronchoscope guided advancement

During the anesthetic induction for thoracic surgery, Lt. DLT is intubated using the bronchoscope-guided method. The method is as follows. 1. Lt. DLT is intubated through vocal cord using the direct laryngoscopy. 2. Pass the fiberoptic bronschoscope through a bronchial lumen of Lt. DLT. 3. Secure the pathway into the Lt. main bronchus by advancing the bronchoscope into the Lt. main bronchus. 4. Lt. DLT can be advanced through the guide of the bronchoscope into Lt. main bronchus. 5. After the advancement, the position of Lt. DLT can be confirmed using the fiberoptic bronchoscope. If necessary, the depth and direction of Lt. DLT should be modified.

PROCEDURE

Conventional advancement

During the anesthetic induction for thoracic surgery, Lt. DLT is intubated using the conventional method. The method is as follows. 1. Lt. DLT is intubated through vocal cord using the direct laryngoscopy. 2. Rotate Lt. DLT 90 degrees to the left side. 3. Advance Lt. DLT blindly to main bronchus level. 4. After the advancement, the position of Lt. DLT can be confirmed using the fiberoptic bronchoscope. If necessary, the depth and direction of Lt. DLT should be modified.

Sponsors & Collaborators

• Seoul National University Bundang Hospital

  lead OTHER

Principal Investigators

• Jin-Woo Park, MD · Seoul National University Bundang Hospital

Study Design

Allocation

RANDOMIZED

Purpose

PREVENTION

Masking

DOUBLE

Model

PARALLEL

Eligibility

Min Age

20 Years

Max Age

75 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2018-01-15

Primary Completion

2019-01-30

Completion

2019-01-31

Countries

• South Korea

Study Locations