Double-lumen tube malfunction caused by the carinal hook

Left double-lumen tube with or without a carinal hook: A randomised controlled trial

BACKGROUND

Left double-lumen tracheal tubes (DLTs), with or without a hook to engage the carina, remain the standard device for lung isolation during anaesthesia.

OBJECTIVE

The purpose of the study was to compare these DLTs with and without a hook.

DESIGN

A randomised, controlled, single-blinded study.

SETTING

University hospital.

PARTICIPANTS

One hundred and eighty-four patients undergoing lung resection.

MAIN OUTCOME MEASURE

Time required to position the tube from the introduction of the tube into the mouth to confirmation of correct placement in the supine position.

RESULTS

Baseline characteristics were well balanced between the groups. Time to place DLTs was similar in both groups: median (interquartile range, IQR) 81.0 (50.0 to 146.2) s for DLTs without a hook and 67.5 s (45.0 to 138.7) for DLTs with a hook (P = 0.43). The incidence of adequate position at the first attempt was 68.5% in the No hook group and 69.6% in the Hook group (P = 0.95). Patients in both groups suffered similar incidences of sore throat at day 0 and day 1 (P = 0.80 and P = 0.20, respectively). No major lesion of the vocal cords or tracheobronchial tree was discovered and the incidence of minor lesions was similar in both groups.

CONCLUSION

When a DLT is used, the presence of a carinal hook gives neither advantage nor added complications.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT00969683.

"Detachment of the carinal hook following endobronchial intubation with a double lumen tube"

Background

Carinal hooks increases difficulty at endotracheal intubation. Amputation of the carinal hook during passage and malpositioning of the tube to the hook are some of the potential problems related with left-sided Carlens double lumen tube (DLT). This article reports an amputation of the hook during a difficult selective intubation and aimed at calling the attention to complications associated with DLTs and the importance of fiberoptic bronchoscopy.

Case presentation

A 68 year-old woman was scheduled for right-sided thoracotomy in whom blind DLT insertion was performed. Narrowed trachea causes difficulty in rotating the DLT 90° counter-clockwise. After carinal hook was noticed upon visual inspection of the DLT, fiberoptic bronchoscopy was used to remove the missing part (with the use of forceps) from the right mainstem bronchus.

Conclusion

Insertion of DLTs with carinal hook is associated with technical problems and potentially life-threatening hazards have discouraged their use. Fiberoptic evaluation and repositioning solves most of the problems. Although amputation of the carinal hook has not been previously reported, clinicians should be alert. This case report emphasizes the utility of the fiberoptic bronchoscopy in the operating theatre for placement, positioning and inspection of the carinal hook DLT.

A comparison of the deflecting-tip bronchial blocker with a wire-guided blocker or left-sided double-lumen tube

OBJECTIVE

To compare a new bronchial blocker, the Cohen blocker, with the Arndt blocker and a left double-lumen tube (DLT).

DESIGN

A prospective, randomized, controlled trial.

SETTING

University hospital.

PARTICIPANTS

Forty-eight patients undergoing lung surgery.

INTERVENTION

Intubation with 1 of the 3 devices. Comparisons among groups included (1) time for initial positioning, (2) degree of lung collapse at pleura opening, and (3) number of intraoperative fiberoptic examinations.

MEASUREMENTS AND MAIN RESULTS

Positioning of the Cohen blocker (256 [166-341] seconds; median [interquartile range]) took no longer compared with the Arndt blocker (253 [184-305] seconds), and there was a trend toward difference between the 2 blockers and the DLT (137 [102-199] seconds) (p = 0.07). The time to place the Cohen blocker was longer in cases of left bronchus occlusion compared with a right one (340 [300-450] v 170 [124-259] seconds, p = 0.02); they were similar in the Arndt group. The degree of lung collapse was different among groups (p = 0.05), but the difference between any pair did not reach statistical significance. The number of patients who required at least 1 additional FOB examination was not statistically different (50% of patients in each blocker group v 19% in the DLT group).

CONCLUSIONS

There was a trend toward a difference between times to place a bronchial blocker and the DLT. The Cohen blocker is more difficult to position in the left main bronchus than in the right one.