The Role Of Fiberoptic Bronchoscope In The Positioning Of Robertshaw Double-lumen Endobronchial Tube

Backgroud The use of disposable polyvinyl chloride Robertshaw Double-lumen endobronchial tube (DLT) is well accepted in thoracic surgery. Correct position of DLT is essential for optimal gas exchange during one-lung ventilation. Auscultation is an unreliable method of confirming the position of DLT. FOB has been recommended to verify the position of DLT in many countries. But the reports concerning FOB in positioning of Robertshaw DLT were very few in China.Objective The aim of this study was to address the role of FOB for placing and monitoring right- and left-sided PVC-Robertshaw DLT in Chinese patients after blind intubation and patient positioning.Methods One hundred and sixty-five ASA I ~ II patients who underwent thoracic operation requiring OLV were studied. After anesthesia induction, a selected Portex Robertshaw DLT was inserted by one anesthetist. Bronchoscopy was performed-3-by another anesthetist after intubation and auscultative verification of correct placement and after patient positioning for thoracotomy. A DLT was considered malplacement when it was moved >0. 5cm to accurate its position. Critical malposition was those that might have affected patient safety and influenced the surgical procedure. Then the results were recorded. Meanwhile Paw and Sp02 during one-lung ventilation were recorded. Results After blind intubation and patient positioning, DLT were found to be displaced in 75.8% and 43.0% by Bronchos copy. Distal malposition were similar with proximal malposition after intubation. But after positioning, proximal malposition occurred more frequently than distal malposition. Most of critical malposition occurred after intubation. Right-sided DLT were significantly more likely to be displaced than were left-sided DLT. The design for the bronchial cuff and the right upper lobe ventilation slot of the Portex right-sided DLT matched imperfectly with the anatomization of the Chinese right upper lobe bronchus. Conclusion The use of FOB as a diagnostic tool in-4-positioning the Robertshaw PVC-DLT both after blind intubation and after patient positioning is reliable and necessary. Moreover right-sided DLT should be routinely positioned by FOB.