Combined Adjustment Of Different Methods In Patients With Double Thoracic Surgery And Different Depth Can Influence Incidence Of Malposition From The Supine To The Lateral Decubitus Position

Objective: Thoracic surgery commonly used double-lumen endobronchial tube (DLT). correct positioning of the DLT is the key to thoracic anesthesia,otherwise it happens severe complications in operation. DLT currently is used Robertshaw DLT, there is not bulge hook,because of easy intubation, reducing the vocal cord and trachea injury. It is widely used in clinical practice, intubation feeling is not clear, correct positioning of the DLT is different, it easily happens malposition, affecting one-lung ventilation. Although fiberoptic bronchoscopy is correctly positioned DLT, coverage is not high in our country. Separately auscultation method, airway pressure changes, end-tidal carbon dioxide partial pressure (PetCO₂) to locate the DLT, is also not satisfied. The traditional criteria: the upper surface of the left endobronchial blue cuff just below the carina. Foreign reports that dislocation rate is 43% 72% following lateral positioning of the patient, which is major to proximal malposition, Desiderio, stated that it is actually advantageous to have the endobronchial cuff at least 1 cm inside the left mainstem bronchus,but the catheter intubate too deeply,it increase complications.The research purposes to observe the correctly positioning rate of f left-sided double lumen endobronchial tube by combined adjustment of ausculation, PetCO₂ and airway pressure changes and to explore that different depth can influence incidence of malposition from the supine to the lateral decubitus position.Methods: sixty adult patients undergoing thoracic surgery were intubated with RobertshawDLTs.ausculation standard: Two Lung ventilation(TLV), the breath sounds is the same to pre-intubation, one-lung ventilation(OLV),the ventilative side is the same to pre-intubation, breath sounds disappear in non-ventilative side.PetCO₂ standard: As TLV, curve of PetCO₂ is normal,PetCO₂ is in the normal range. One-lung ventilation,in the ventilative side,PetCO₂ decline upper limit 5%.airway pressure changes standard: Inspiratory peak airway pressur(ePpeak)doesn't excess 25 H2O,and there isn't a increase more than 65% of the baseline in Ppeak when switching from TLV to OLV. DLT position is checked and adjusted by fiberoptic bronchoscope(FOB), via the right tracheal lumen(Fig. 1),(1) accurate place:that the carina is midway between the black radiopaque line and the top of the bronchial cuff,it is 10～11 mm(A- B),(2) shallow place:a small part of the left endobronchial blue cuff is above the tracheal carina,but there is not hernia(Fig. 6),(3) deeper place the black radiopaque line is beyond the tracheal carina(A- D) (Fig. 11),(4) shallower place: the left endobronchial blue cuff becomes hernia to the right main bronchus,looking down the left endobronchial lumen,the orifice of the left superior lobe bronchus and the orifice of the left inferior lobe bronchus should be seen clearly.We define that"accurate place"and"shallow place"are Successful;another 60 adult patients undergoing thoracic surgery were intubated with RobertshawDLTs. To adjust positioning of left double-lumen tube ,and randomly assign three groups: groupâ… : In the supine Position, via the right tracheal lumen,the endoscopist should see a clear,straight-ahead view of the tracheal carina, it is important to see the upper surface of the left endobronchial blue cuff just below the carina, then looking down the left endobronchial lumen, the orifice of the left superior lobe bronchus and the orifice of the left inferior lobe bronchus should be seen clearly. groupâ…¡: The proximal shoulder edge of the blue bronchial cuff should not be visualized at the carina. However, through the left bronchial lumen,and by transparency across the wall of the tube, the position of the tube is adjusted so that the carina is midway between the black radiopaque line and the top of the bronchial cuff.Finally, the orifice of the left superior lobe bronchus and the bronchial carina should be clearly seen. groupâ…¢: via the right tracheal lumen, the black radiopaque line should be visualized at the carina,the orifice of the left superior lobe bronchus and the orifice of the left inferior lobe bronchus should be seen clearly.Results: In the supine position, successful intobution patients is 57 cases by three combined methods,one of cases is shallower,two of cases are deeper,DLT satisfactory rate is 95 percents;In the lateral decubitus position, successful intobution is 56 cases by three combined methods,two of cases is shallower,two of cases are deeper,DLT satisfactory rate is 93.4 percents, without significant hypoxemia and hypercapnia anesthetic complications; L-DLT dislocated to proximal malposition is significantly less in theâ…¡,â…¢groups compared to theâ… groupï¹™p<0.05﹚,â…¡,â…¢are not differentï¹™p>0.05﹚,Three groups to caudal displacement are not differentï¹™p>0.05﹚, The incidence of repositioning is significantly less in theâ…¡,â…¢groups compared to theâ… groupï¹™p<0.05﹚,â…¡,â…¢are not differentï¹™p>0.05﹚.Conclusions: That auscultation method,airway pressure changes and PetCO₂ are combined is simple,reliable can be used repeatedly during postural changes without increasing the opportunities for injury,it is clinically a very good approach,the experimental result shows that DLT satisfactory rate is about 95 percents, FOB is necessary for positioning; depth can reduce incidence of malpositioning from the supine to the lateral decubitus position inâ…¡,â…¢, suitable depth is that the blue bronchial cuff is intubated into the left main bronchus from 0.5cm to 1cm.