Comparison Of Clinical Efficacy Of Disposcope-guided Double-lumen Endobronchial Tube Placement Versus Fiberoptic Bronchoscopy-guided Techniques

Objective To compare the clinical efficacy of Discoscopeendoscope(DE)and fiberopticbronchoscopy(FOB)-guided techniques for double-lumen endobronchial tube placement.Methods Fifty adult patients aged 20–71 years, weight 45–85 kg, ASA I-II, scheduled for elective thoracic surgery with left double-lumen endobronchial tube were enrolled. Patients with anticipated difficult airway were excluded. Patients were randomly allocated into either DE group(n=25) or FOB group(n=25). The hemodynamic parameters including heart rate(HR), systolic blood pressure(SBP), mean arterial pressure(MAP), and HR-blood pressure product(RPP) were recorded at the following time points: before anesthesia(baseline, T0), before intubation after anesthesia induction(T1), the moment for glottis exposure(T2), the moment for successful tracheal intubation(T3), 1 minute(T4) and 3 minutes(T5) after tracheal intubation. The maximum and minimum HR and MAP(HRmax, HRmin, MAPmax, MAPmin) during the entire period were also documented. The other data were collected regarding the intubation time, the first attepmpt success rate, incidence of difficult insertion, and the postoperative airway-related complications(arytenoid dislocation, pharyngagia, hoarseness, and tooth dislocation).Results In comparison to FOB group, the intubation time was shorter and the incidence of difficult insertion was lower in DE group(P<0.05), although the first attempt success rate was comparable between the two groups(100% in FOB groups vs88% in DE group, P>0.05). Compared with the baseline value in either own group, the HR, MAP and RPP at T1 and T2 were decreased significantly in both groups(P<0.05); HR(at T3, T4 and T5) and MAP(at T3 and T4)in both groups Increased notably(P<0.05). RPP(at T4 in DE group and at T4 and T5 in FOB group) significantly increased(P<0.05). In comparison to FOB group, HR(at T3 and T4), MAP(at T4 and T5) and RPP(at T3, T4 and T5) in DE group were reduced significantly(P<0.05). The incidence of postoperative pharyngalgia was lower in DE group than that in FOB group(P<0.05). There was no significant difference in the incidence of postoperative hoarseness between the two groups(P>0.05). No arytenoid dislocation and tooth dislocation were observed in either of the groups.Conclusion Compared with the FOB-guided technique, the Disposcope endoscope-guided placement of double-lumen endobronchial tube has a more favorable ease of insertion with shorter intubation time and is associated with minimal hemodynamic stress response and a low incidednc of postoperative adverse events.