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Double-lumen tube placement using a retractable carinal hook: a preliminary report
Roshdi R Al-Metwalli1, Hany A Mowafi, Salah A Ismail
1Department of Anesthesiology, Faculty of Medicine, King Faisal University, Saudi Arabia. rmetwally@hotmail.co
Anesthesia and Analgesia
|July 18, 2009
Summary
A modified double-lumen tube (DLT) placement technique using a carinal hook significantly improves correct positioning success rates. This method also reduces the time needed for confirmation and adjustment, enhancing patient safety during anesthesia.
Area of Science:
- Anesthesiology
- Thoracic Surgery
- Medical Devices
Background:
- Accurate placement of double-lumen tubes (DLTs) is critical for effective one-lung ventilation during thoracic surgery.
- Conventional blind DLT placement methods can lead to malpositions, necessitating adjustments and potentially prolonging procedures.
- A novel technique involving a retractable carinal hook was developed to aid in left-sided DLT placement.
Purpose of the Study:
- To evaluate the efficacy of a modified DLT placement method using a retractable carinal hook compared to the conventional blind technique.
- To assess the impact of the modified method on the success rate of initial correct tube positioning.
- To determine if the modified method affects the time required for DLT placement and confirmation.
Main Methods:
- A prospective, randomized, controlled trial was conducted with 40 patients requiring left-sided DLTs.
- Patients were randomized into two groups: conventional DLT placement (n=20) and modified placement with a carinal hook (n=20).
- Correct tube positioning was confirmed using fiberoptic bronchoscopy (FOB), and incidences of malposition and placement times were recorded.
Main Results:
- The modified hook group demonstrated a significantly lower incidence of DLT malposition (10%) compared to the conventional group (45%) (P = 0.03).
- Clinical assessment alone detected fewer malpositions in the hook group (5%) versus the conventional group (15%).
- While clinical placement time was similar, FOB confirmation and adjustment time was significantly shorter in the hook group (88.9 s) than the conventional group (152.3 s) (P < 0.0001).
Conclusions:
- The use of a retractable carinal hook enhances the success rate of correct double-lumen tube positioning.
- This modified technique significantly reduces the time required for fiberoptic bronchoscopy confirmation and adjustment.
- Further large-scale studies are warranted to confirm the safety and reliability of the carinal hook method for DLT placement.
