Frequently Asked Questions

No consensus exists as to how to best determine DLT size, and most anesthesiologists choose the DLT size based on their personal experience. Use of the following height/gender criteria, “women <1.6 m (63 in), 35 Fr; women >1.6 m, 37 Fr; men <1.7 m (67 in), 39 Fr; and men >1.7 m, 41 Fr,” resulted in a >90% incidence of successful positioning and a similar rate of effective lung separation.

Reference:

Duthie DJR, O’Leary R. Double lumen endobronchial tube (DLT) sizes in routine practice . European J Anaesthesiol. 2012;29:231.

The role of VL for DLT intubation is unclear because the larger size DLT and the discrepancy between the curves of the DLT and the VL blade may affect visualization of the vocal cords, and therefore intubation success. Results of clinical studies of VL for DLT placement have been mixed.

Several mechanisms may explain the combination of adequate laryngoscopic view but prolonged intubation time with VL. One possibility is that most VL blades are more angulated than DL blades. However, because camera position is lower on the blade, laryngoscopic views are good even though manipulating the endotracheal tube (ET) tube around the more acute angle of the VL blade may be difficult. The tip of the DLT may also hit the ventral wall of the trachea when advancing beyond the vocal cords, which necessitates the performance of ELM in as many as one-third of the patients during VL intubation.

Reference:

Yao et al. A comparison of the McGrath® Series 5 videolaryngoscope and Macintosh laryngoscope for double-lumen tracheal tube placement in patients with a good glottic view at direct laryngoscopy. Anaesthesia July 2015.

A new development in BB design is the EZ-Blocker (Teleflex Medical), which is a Y-shaped catheter with two 4-cm-long color-coded distal balloon–tipped extensions. The “Y” then straddles the carina, and the 2 high-pressure low-volume balloons reside in each main stem bronchus. Because it does not matter which tip is in which bronchus, the EZ-Blocker can often be positioned without FB. 

Reference:

Son et al. Successful use of an EZ-blocker for lung isolation and management in a hemoptysis patient. Ann Transl Med. 2019.

Of current interest is the potentially beneficial effect of inhaled anesthetics on pulmonary inflammation. Several recent comparisons between inhaled anesthetics and propofol have observed an attenuated inflammatory response with inhaled anesthetics that has inconsistently translated into fewer postoperative pulmonary complications.

Reference:

Beck-Schimmer B et al. Which anesthesia regimen is best to reduce morbidity and mortality in lung surgery?: a multicenter randomized controlled trial. Anesthesiology. 2016.

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