Bronchial blocker compared to double-lumen tube for one-lung ventilation during thoracoscopy

Background: Video-assisted thoracoscopic surgery (VATS) requires one-lung v entilation with a properly collapsed lung. This study compared the Broncho- Cath double-lumen endotracheal tube with the Wiruthan bronchial blocker to determine the advantages of one device over the other during anaesthesia wi th one-lung ventilation for thoracoscopy. Methods: Thirty-five patients undergoing VATS were randomly assigned to one of two groups. Sixteen patients received a left-sided double-lumen tube (D LT) and nineteen a Wiruthan bronchial blocker (BB). The BE group was subdiv ided in two: BE in the right mainstem bronchus (BBR) for right-sided VATS ( 9 patients), BE in the left mainstem bronchus (BBL) for left-sided VATS (10 patients). The position of the devices was checked using a fibreoptic bron choscope. The following variables were measured: 1) number of unsuccessful placement attempts; 2) number of malpositions of the devices; 3) time requi red to place the device in the correct position; 4) number of secondary dis lodgements of the devices after turning the patient into the lateral decubi tus position. The quality of lung deflation was evaluated by the surgeons w ho were blinded to the type of tube being used. Results: The number of unsuccessful placement attempts was one in the DLT g roup (1/16), three in the BBL group (3/10) and none in the BBR group (0/9). The number of malpositions was significantly greater in the BBL group (10/ 10) compared to the DLT group (2/16) and to the BBR group (1/9) (P<0.001). The time (mean+/-SD) required to place a BBL was 4.21 min+/-1.28, significa ntly longer than the time required to place a DLT (2.26 min+/-0.55, P<0.000 6) or a BBR (2.41 min+/-0.53, P<0.008). The difference in placement time be tween DLT and BBR was not significant. The number of secondary dislodgement s was one in the DLT group, one in the BBR group and none in the BBL group (NS). The quality of lung deflation was judged excellent or fair in all pat ients in the DLT and the BBL groups and poor in 44% of the patients in the BBR group. Conclusion: It took significantly longer to place a left BE than a DLT (P<0 .0006) or a right BE (P<0.008). The number of initial malpositionings of th e left BE was significantly greater than in the other groups (P<0.001). The quality of lung deflation was better in the BBL and in the DLT groups than in the BBR group. We conclude that for routine use during left-sided VATS, the use of a DLT is preferable to a left BE because of its greater ease of placement. For right-sided VATS, DLT and right BE showed the same facility of placement but the DLT provided a better quality of lung deflation.