Home | | Clinical Cases in Anesthesia | Which sided double-lumen endobronchial tube should be used for this patient?

Chapter: Clinical Cases in Anesthesia : One-Lung Anesthesia

Which sided double-lumen endobronchial tube should be used for this patient?

There is no one correct answer to this question. Different approaches to the choice of double-lumen endobronchial tube depend on the side of thoracotomy.

Which sided double-lumen endobronchial tube should be used for this patient?

 

There is no one correct answer to this question. Different approaches to the choice of double-lumen endobronchial tube depend on the side of thoracotomy. In this case of a left thoracotomy, either a left- or right-sided tube can be selected. These authors agree that left-sided tube placement is more prudent in this situation. In the adult, the left mainstem bronchus is 4–5 cm in length, compared with 2–3 cm for the right mainstem bronchus. The right upper lobe bronchus is more likely to be accidentally occluded by the endobronchial tube than is the left upper lobe bronchus. Resection of the left lung will necessitate continuous ventilation of the right lung. Obstruction of the right upper lobe bronchus would likely lead to hypoxemia during one-lung ventilation. For this reason, some anesthesiologists routinely place a left-sided double-lumen tube, regardless of the side of thoracotomy, unless this is specifically contraindicated by the presence of a diseased left mainstem bronchus, or if the bronchus will likely become part of the surgical field.

Some anesthesiologists routinely place the endo-bronchial tube on the side ipsilateral to pulmonary resec-tion. With this arrangement, obstruction of the upper lobe bronchus by the endobronchial tube is not as likely to cause hypoxemia because this is the lung to be deflated during one-lung ventilation. Also, before chest closure, reinflation of the remaining lung ipsilateral to the tube can be verified by direct inspection. Failure to reinflate the upper lobe is treated by deflation of the bronchial cuff so that it can be ventilated from the tracheal lumen. Alternatively, the double-lumen tube can be withdrawn until the distal end of the endobronchial tube is proximal to the upper lobe bronchial orifice. In the case of a pneu-monectomy, the tube must be withdrawn to a position where the distal end of the tube is in the trachea before divi-sion of the main bronchus. Withdrawal may also become necessary if the intubated bronchus is involved in the surgery.

 

A different approach used by a smaller percentage of anesthesiologists is to routinely place the double-lumen tube into the nonoperative side. This strategy prevents damage from placing the tube into a diseased bronchus. Placement of a right-sided tube for a left thoracotomy, however, may lead to hypoxemia during one-lung ventilation, as discussed.

 

Our approach is to place a left-sided double-lumen tube for both left and right thoracotomies, unless contraindicated by anatomy or pathology. However, during a right thoracotomy performed under this arrangement, misplacement of the endobronchial tube too distal in the left bronchus will occlude the left upper lobe, predisposing the patient to hypoxemia dur-ing one-lung ventilation. This is because only the left lower lobe will be ventilated during right lung deflation.

 

Study Material, Lecturing Notes, Assignment, Reference, Wiki description explanation, brief detail
Clinical Cases in Anesthesia : One-Lung Anesthesia : Which sided double-lumen endobronchial tube should be used for this patient? |


Privacy Policy, Terms and Conditions, DMCA Policy and Compliant

Copyright © 2018-2024 BrainKart.com; All Rights Reserved. Developed by Therithal info, Chennai.