PLACEMENT OF LEFT DOUBLE-LUMEN ENDOBRONCHIAL TUBES WITH OR WITHOUT A STYLET

Purpose: This study was designed to determine if leaving a styler in t he left Bronch-Cath(R) endobronchial tube (DLT) for the entire intubat ing procedure improves the accuracy of placement on the initial attemp t without introducing complications. Methods: Sixty ASA 1-3 patients w ere randomized to one of two groups. In Group 1 (n = 30), the styler w as retained for the entire intubation procedure and in Group 2 (n = 30 ), the stylet was removed once the bronchial cuff had passed the vocal cords. In both groups, the DLT was turned 110 degrees counterclockwis e and advanced until resistance was encountered. Placement was assesse d by auscultation and fibreoptic bronchoscopy (FOB). After surgery, th e DLT was replaced by a single-lumen endotracheal tube. The thoracic s urgeon (blinded to the method of intubation, and using a FOB) assessed the appearance of the tracheobronchial mucosa. Results: The two group s were similar with respect to sex, height, weight, DLT size, surgeon and expertise of the laryngoscopist. When the styler was retained, the DLT was correctly placed 60% of the time compared with 17%, if the st ylet was removed, (P = 0.001). Seven out of 30 DLTs in Group 2 were in itially placed into the right mainstem bronchus, (P = 0.005). The aver age time to confirmation of correct tube placement by FOE was increase d in Group 2, (P = 0.01). Although the observed incidence of left bron chial, mucosal petechiae and erythema was greater in Group 2, this was not statistically significant, (P = 0.063). Conclusion: Retaining the stylet for the entire intubation procedure allows for a more rapid, a ccurate placement of the DLT without increasing the incidence of trach eobronchial mucosa injury.