LEFT DOUBLE LUMEN ENDOTRACHEAL TUBE: BRONCHOSCOPIC FINDING AFTER CONFIIRMATION OF CORRECT POSITION OF TUBE WITH AUSCULTATION

Abstract

Objective: To determine the frequency of malposition of left sided double lumen endotracheal tube with fiber-optic bronchoscope after its correct positioning by auscultation.

Study Design: Prospective observational study.

Place and Duration of Study: Main operation theater, Combined Military Hospital, Rawalpindi, from Jul 2015 to Dec 2016.

Methodology: After approval from ethical review committee and consent, 90 patients with American Standards Association (ASA) II and III status were included in study by consecutive sampling. Proper monitoring attached and patients were premedicated. After induction of general anesthesia left sided double lumen tube was inserted by direct laryngoscopy. After inflation of cuffs, auscultation was done to determine correct position of tube. Then position of tube was confirmed by fiber optic bronchoscope.

Results: The mean age was 38.13 ± 15.43 years and 66 (73.3%) males. In all the patients, auscultation showed that the left sided double lumentube were in the correct position with adequate ventilation of left upper and lower lobes. However, flexible bronchoscopy showed that double lumentubes had been placed correctly in only 54 (60%) cases, while 36 (40%) cases had partially misplaced double lumentubes. Out of these 36 cases, 26 (72.2%) had distally malpositioned double lumentube and 10 (27.8%) patients had proximally displaced double lumentube.

Conclusion: Auscultation was found an unreliable method for confirmation of correct position of double lumentube and fibreoptic bronchoscope should be used for the confirmation of correct position of double lumentube for better anesthetic management in one lung ventilation.