Clinical Study Of Video Laryngoscope For Double-lumen Tube Intubation

Objective:Double-lumen endobronchial tubes are widely used in thoracic surgery and provide excellent conditions for lung isolation and one-lung ventilation.Compared with single-lumen tubes,they are longer,wider and less compliant,which have encountered many difficulties in clinical application.Various video laryngoscopic devices,in spite of the successful achievement of better laryngeal views,have failed to deliver the tip of the tube to the glottis opening accurately.There are various factors such as oral space,pre-shaped angulation,direction of tube tip and experience of anesthesiologists are all correlated with first pass success.Of which,reasonable tube shaping is a crucial step to deliver the tube to the glottis effectively and accurately then pushing it into the airway.Therefore,this study was designed to compare the advantage of different tube shapes on the first pass success rate in double-lumen tube intubation with video laryngoscopy.And to explore the key factors affecting the success of double-lumen tube intubation with video laryngoscope.Methods:A randomised,controlled trial was conducted in 300 patients over the age of 18 who undergoing elective thoracic surgery using double-lumen tube for lung separation.The participants were prospectively randomized into three groups: Group A,take the lower edge of the main tracheal cuff approximately 2cm,near the upper edge of the lateral tube opening,bend it nearly 90° and straighten the tube above the cuff,keeping the bevel of the tube tip in a left-right direction;Group B,preserving the original shape of the double-lumen tube,take the lower edge of the main tracheal cuff approximately 2cm,near the upper edge of the lateral tube opening,bend it nearly 90°,keeping the bevel of the tube tip in a anterior-posterior direction;Group C,preserving the original shape of the double-lumen tube,the angulation of the tube is consistent with intubation undergoing Macintosh laryngoscope.The primary outcome was first pass success rates.The secondary outcomes included number of intubation attempts,intubation time(defined as the time from inserting tube to observing capnography curve),incidence of malposition,haemodynamic responses and oropharyngeal mucosal injury(hoarseness or sore throat on the first postoperative day).Results:All 300 patients included in the study completed intubation.There was no signifcant differences in patient characteristics or airway assessments among three groups(P>0.05).Such as age,height,weight,gender,American Society of Anaesthesiology(ASA)physical status,interincisor distance,thyromental distance,Mallampati classification,and Cormack-Lehane grade.Compared with Groups C,Group A and Group B exhibited a higher first pass success rate(92% vs 94% vs 69%;P<0.001).However,there is no signifcant difference in first pass success rate between Group A and Group B(P>0.05).And the number of the intubation was lower in groups A and B compared with group C(1.10±0.39 vs 1.07±0.29 vs 1.37±0.61;P<0.05).There was no statistical difference in intubation time among the three Groups.At the same time,the incidence of malposition in group A was higher than groups B and C,and the difference was statistically significant(P<0.05).Additionally,there was no statistically significant difference in the risk of complications such as systolic blood pressure and heart rate changes and pharyngeal injury between the three groups before and after intubation(P>0.05).Conclusion:Placement of a double-lumen endotracheal tube witn video laryngoscope,using the preshaping strategy of group A and group B in this study,together with the techniques used at different stages of the intubation process,which can improve the first pass succes rate of intubation.