ROLE OF FIBEROPTIC BRONCHOSCOPY IN CONJUNCTION WITH THE USE OF DOUBLE-LUMEN TUBES FOR THORACIC ANESTHESIA - A PROSPECTIVE-STUDY

Background: Fiberoptic bronchoscopy has been recommended to verify the position of double-lumen tubes (DLT), but this remains controversial. The authors studied the role of bronchoscopy for placing and monitori ng right-and left-sided DLTs after blind intubation and after position ing the patient. Methods: Two hundred patients having thoracic surgery requiring DLT insertion were prospectively studied. ''Blind'' trachea l intubations were done with 163 left-sided and 37 right-sided disposa ble polyvinyl chloride Robertshaw tubes. Bronchoscopy was performed by a different anesthesiologist after intubation and conventional clinic al verification of correct placement and after patient positioning for thoracotomy. A DLT was considered malpositioned when it had to be mov ed >0.5 cm to correct its position. Critical malpositions were those t hat might have affected patient safety or influenced the surgical proc edure if left uncorrected. Results: After ''blind'' DLT intubation, cl inical evidence of malpositioning was found in 28 patients. This was c onfirmed by fiberoptic assessment. in 172 patients in whom placement w as judged correct by clinical assessment, malpositioning was detected by bronchoscopy in 79 cases, 25 of which were critical. After patient positioning, DLTs were found to be displaced in 93 patients, 48 of whi ch were critical. Right-sided DLTs were significantly more likely to b e malpositioned than were left-sided DLTs. Two complications were rela ted to unsatisfactory lung separation in the 200 patients studied. Con clusions: After blind intubation and patient positioning, more than on e third of DLTs required repositioning. Routine bronchoscopy is theref ore recommended after intubation and after patient positioning.