Benefits of Exchanging a Double Lumen Tube to a Proseal Laryngeal Mask or a Single Lumen Tube After a Thoracic Surgery
Condition: Cough; Laryngospasm; Apnea; Desaturation; Voice Hoarseness
MeSH terms: Hoarseness; Dysphonia; Laryngismus
Study type: Interventional
Phase: Phase 3

Summary: 
      The purpose of this study is to determine whether exchange of the double lumen tube before
      emergence with a laryngeal mask airway (Proseal) or a tracheal tube will reduce cough at
      emergence.
    

Detailed description: 
      Intubation with a double lumen tube is often the preferred method to ensure isolation of the
      lung and proper exposition of the surgical site during thoracoscopies and thoracostomies.
      Unfortunately, because of the length and diameter of the double lumen tube, it is known to
      cause more irritation in the upper airways thereby inducing cough at emergence. In turn,
      cough has been associated with numerous multisystemic complications. Severe respiratory
      complications include laryngospasm or upper airway obstruction, desaturation, vocal cord
      injury, tracheal and bronchial ruptures. The purpose of this study is to determine whether
      exchange of the double lumen tube before emergence with a laryngeal mask airway (Proseal) or
      a tracheal tube will reduce cough at emergence.
    

Intervention name(s): LMA Proseal; Tracheal tube
Intervention type(s): Device; Device
Intervention description(s): Once surgery is completed, the patient is transferred onto a gurney. Train of four is checked. Patient is ventilated with 100% oxygen. Remifentanil 0.5 ug/ml IV is administered. 30 seconds to 1 minute later, secretions are suctioned. Depth of anesthesia is ensured by deflating, inflating, then deflating the tracheal balloon of the DLT and checking for absence of movement, swallowing, or coughing. The DLT is removed, then the LMA proseal is inserted. Respiratory and hemodynamics parameters are noted. Tolerance of the exchange (presence of cough, movement, laryngospasm, desaturation) is noted. Inhalational gas is stopped. Reversal agent is administered if appropriate. Spontaneous breathing is titrated for <12 with boluses of fentanyl 25ug or sufentanil 2.5ug q 5mins.
If failure to insert Proseal occurs, a second attempt is made after deepening anesthesia with propofol 1mg/kg and remifentanil 0.5ug/kg IV. If failure occurs again, the patient is intubated with a tracheal tube.; Once surgery is completed, the patient is transferred onto a gurney. Train of four is checked. Patient is ventilated with 100% oxygen. Remifentanil 0.5 ug/ml IV is administered. 30 seconds to 1 minute later, secretions are suctioned. Depth of anesthesia is ensured by deflating, inflating, then deflating the tracheal balloon of the DLT and checking for absence of movement, swallowing, or coughing. The DLT is removed, then a tracheal tube (size 7 for women, size 8 for men) is inserted. Respiratory and hemodynamics parameters are noted. Tolerance of the exchange (presence of cough, movement, laryngospasm, desaturation) is noted. Inhalational gas is stopped. Reversal agent is administered if appropriate. Spontaneous breathing is titrated for <12 with boluses of fentanyl 25ug or sufentanil 2.5ug q 5mins.
Other intervention name(s): Proseal, laryngeal mask airways; Single lumen endotracheal tube
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Prevention
Keywords: Exchanging double lumen tube with laryngeal mask Proseal; Exchange double lumen tube with tracheal tube; Exchange double lumen tube before emergence decrease cough; thoracoscopy and postoperative respiratory complications; thoracostomy and postoperative respiratory complications; postoperative cough; postoperative respiratory complications; laryngeal mask and postoperative respiratory complications