Endobronchial intubation in thoracic surgery: Which side should be preferred?

Area of Science:

• Anesthesiology and Thoracic Surgery

Background:

• Double-lumen endotracheal tubes (DLTs) are crucial for lung isolation in thoracic surgery.
• Proper DLT placement ensures adequate ventilation and surgical conditions.
• The choice between right-sided DLTs (R-DLTs) and left-sided DLTs (L-DLTs) can impact clinical outcomes.

Purpose of the Study:

• To compare the clinical performance of R-DLTs versus L-DLTs.
• To evaluate outcomes when DLTs are placed without fiberoptic bronchoscopy guidance.
• To determine the preferred DLT side for thoracic surgery in specific scenarios.

Main Methods:

• Retrospective review of 80 thoracic surgery patients (January 2013 - February 2014).
• Analysis of clinical performance metrics including hypoxia, hypercapnia, and lung deflation.
• Comparison of outcomes between patients receiving R-DLTs (n=33) and L-DLTs (n=47).

Main Results:

• R-DLTs were associated with significantly higher rates of perioperative hypoxia, hypercapnia, and inadequate lung deflation (p<0.05).
• Post-anesthesia care unit data revealed more frequent high pCO2, low pH, and high lactate levels with R-DLTs (p<0.001).
• Increased incidence of atelectasis and longer hospital stays were observed with R-DLTs (p<0.001 and p=0.02, respectively).

Conclusions:

• R-DLTs demonstrated poorer clinical performance compared to L-DLTs.
• L-DLTs are recommended for thoracic surgery when fiberoptic bronchoscopy is unavailable.
• Choosing an L-DLT may reduce complications and improve patient recovery.