Successful placement of double lumen endotracheal tube using fluoroscopy

• DOI: 10.4103/0970-9185.105828
• Publication Date: 2013-01-09T19:47:29Z
• Authors: Ankit Maheshwari; Nidhi Sharma; Piyush Mathur
• Keywords: Lumen (anatomy); Right Main Bronchus; Thoracotomy

Sir, Fluoroscopy is increasingly available in operating rooms. There are reports of fluoroscopy use for intubating the trachea patients with difficult airway,[1] positioning an endobronchial blocker,[2] anterograde intubation[3] and placement a single-lumen endotracheal tube children.[4] We used to successfully position double-lumen (DLT) left main stem bronchus after failed attempts standard technique using direct laryngoscopy flexible bronchoscopy. A 65-year-old man carcinoma lung presented two-week history hemoptysis was scheduled embolization culprit vessel, by interventional radiology, under general anesthesia. preoperative computerized tomography scan showed that stent traversing distal bronchus-intermedius right lower lobe had debris plugged causing partial collapse middle lobes. Extensive radiation fibrosis hilum medial upper zone also noted right-sided tracheal deviation. Standard monitoring initiated. radial arterial catheter placed anesthesia induced. left-sided 37 Fr Mallinckrodt double lumen placed.[5] Fiberoptic bronchoscopy mainstem intubation so repositioning attempted Visualization poor due bloody secretions, although frank bleeding not seen. On visualization carina, fiberoptic scope passed into bronchus, which appeared be stenotic. were unable slide tip DLT despite various rotational maneuvers. visualize location DLT, [Figure 1]. Under fluoroscopic guidance, we able perform maneuvres gently bronchus. These maneuvers would have been or impossible without real-time visual guidance.Figure 1: Fluoroscopic frontal image chest shows marked hilar fibrosis, sided deviation (arrow)Fluoroscopy may prove invaluable tool, when insertion through bronchoscope because hemoptysis, bronchial scarring. The simple efficient this situation. Cohen et al.[4] found limited amount instruction, trainees master single quickly infants. guidance allows manipulation control observation from angles. Gentle handling should used, while advancing prevent injury tree. Studies recommended determine efficacy evaluate risks such as