Endobronchial Intubation of Double-lumen Tube: Conventional Method vs Fiberoptic Bronchoscope Guide Method
Condition: Intubation, Intratracheal; Postoperative Complications; Sore Throat; Hoarseness; Soft Tissue Injuries; Thoracic Surgery
MeSH terms: Pharyngitis; Hoarseness; Dysphonia; Postoperative Complications; Soft Tissue Injuries
Study type: Interventional

Summary: 
      Double lumen tube (DLT) needs to be intubated to isolate ventilations of left and right lungs
      for thoracic surgery. Post-operative sore throat and hoarseness are more frequent with DLT
      intubation than with single one. Which is may because DLT is relatively thicker, harder,
      sideway curved and therefore more likely to damage the vocal cord or trachea during
      intubation, and advanced deeper to the carina and main bronchus level. In the conventional
      method of intubation, DLT is rotated 90 degrees and advanced blindly to the main bronchus
      level after DLT is intubated through vocal cord using the direct laryngoscopy. After the
      blind advancement, the sufficient tube position needs to be gained and confirmed with the
      fiberoptic bronchoscope. In the bronchoscope guide method, after DLT is intubated through
      vocal cord using the direct laryngoscopy, the pathway into the targeted main bronchus is
      secured using the fiberoptic bronchoscope which is passed through a bronchial lumen of DLT.
      And then DLT can be advanced through the guide of the bronchoscope. In this study, we intend
      to compare post-operative sore throat, hoarseness and airway injury between the two methods.
      We hypothesize that the bronchoscope guide method can reduce the post-operative complications
      and airway injury because surrounding tissues of the airway can be less irritated by DLT
      intubation in the guide method than in a conventional.

      For a constant guide effect, we use fiberoptic bronchoscopes with same outer diameter (4.1
      mm) which can pass through a bronchial lumen of 37 and 39 Fr Lt. DLT and cannot pass through
      35 Fr or smaller Lt. DLTs.

      <Lt. DLT size selection>

        -  male: ≥160 cm, 39 French; < 160 cm, 37 French

        -  female: ≥160 cm, 37 French; < 160 cm, contraindication
    


Intervention name(s): Bronchoscope guided advancement; Conventional advancement
Intervention type(s): Procedure; Procedure
Intervention description(s): During the anesthetic induction for thoracic surgery, Lt. DLT is intubated using the bronchoscope-guided method. The method is as follows.
Lt. DLT is intubated through vocal cord using the direct laryngoscopy.
Pass the fiberoptic bronschoscope through a bronchial lumen of Lt. DLT.
Secure the pathway into the Lt. main bronchus by advancing the bronchoscope into the Lt. main bronchus.
Lt. DLT can be advanced through the guide of the bronchoscope into Lt. main bronchus.
After the advancement, the position of Lt. DLT can be confirmed using the fiberoptic bronchoscope. If necessary, the depth and direction of Lt. DLT should be modified.; During the anesthetic induction for thoracic surgery, Lt. DLT is intubated using the conventional method. The method is as follows.
Lt. DLT is intubated through vocal cord using the direct laryngoscopy.
Rotate Lt. DLT 90 degrees to the left side.
Advance Lt. DLT blindly to main bronchus level.
After the advancement, the position of Lt. DLT can be confirmed using the fiberoptic bronchoscope. If necessary, the depth and direction of Lt. DLT should be modified.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Prevention