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| The application of small-sized left-sided double-lumen tube to thoracic surgery when combined with low tidal volume ventilation |
| SU Zhonghong SHI Hongwei▲ GE Yali SHI Tao WEI Haiyan |
| Department of Cardiovascular and Thoracic Anesthesiology, Nanjing First Hospital Nanjing Hospital Affiliated to Nanjing Medical University, Jiangsu Province, Nanjing 210006, China |
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Abstract Objective To study the feasibility of small-sized left-sided double-lumen tube for thoracic surgery anesthesia when combined with low tidal volume ventilation. Methods From October 2016 to February 2017, 30 cases of thoracic surgery patients with a single lung ventilation in the left-sided double-lumen tube in Nanjing First Hospital were selected as research objects, and divided into two groups by random number table, with 15 cases in each group. Patients of two groups were treated with different size left-sided double-lumen tubes. The trial group (group T) was applied to the small model, male application F35, female application F32. Control group (group C) was applied to the normal model, male application F37, female application F35. The resistance during intubating, airway trauma testified through fiberoptic bronchoscopy, intubation attempts and hemodynamic changes following intubation were compared between two groups. The airway peak-pressures at the beginning of double-lung ventilation following successful intubation and one-lung ventilation, together with the airway peak-pressure after one-hour′s one-lung ventilation, the oxygen saturation (SPO2) after one-hour′s one-lung ventilation were also compared between two groups. The lowest mean arterial pressure (MAP) and corresponding heart rate (HR) before intubation, the highest MAP and corresponding HR after intubation were recorded. The deviation value between the highest MAP and the lowest MAP, together with the corresponding deviation value of HR, were also compared between group T and group C. Results The resistance during intubating, airway trauma testified through fiberoptic bronchoscopy in group T were lower than those of group C, with statistically significant difference (P < 0.05). There was no statistical difference between two groups in intubation attempts (P > 0.05). During mechanical ventilation, there was no statistical difference between two groups in the double-lung ventilation following successful intubation, one-lung ventilation together with the airway peak-pressure after one-hour′s one-lung ventilation, SPO2 after one-hour′s one-lung ventilation (P > 0.05). In addition, the increased value of HR caused by intubation was less in group-T than in group C (P > 0.05) and the increased value of MAP was also less in group T than in group C (P > 0.05). Conclusion Small-sized left-sided double-lumen tube can satisfy the need of one-lung ventilation when combined with low tidal volume ventilation, and the respiratory tract injury caused by tracheal intubation was more stable.
[Key words] Anesthesia; Endotracheal; Thoracic surgery; Respiration; Artificial; Hemodynamics
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[1] Mourisse J，Liesveld J，Verhagen A，et al. Efficiency，efficacy，and safety of EZ-blocker compared with left-sided double-lumen tube for one-lung ventilation [J]. Anesthesiology，2013，118（3）：550-561.
[2] EI-Boghdadly K，Bailey CR，Wiles MD. Postoperative sore throat：a systematic review [J]. Anaesthesia，2016，71（6）：706-717.
[3] Cools E，Neyrinck AP. Left main-stem bronchus rupture due to a left-sided double lumen tube [J]. Acta Anaesthesiol Belg，2015，66（4）：31-33.
[4] 陈峰，刘杰，朱爱飞，等.胸腔镜下行肺大泡切除致广泛皮下气肿一例[J].临床麻醉学杂志，2014，30（10）：972.
[5] 李刚，张建欣.双腔支气管导管致支气管裂伤两例[J].临床麻醉学杂志，2014，30（7）：723.
[6] Choi DK，Hwang JH，Song MH，et al. Kinking of a left-sided double-lumen tube within the trachea [J]. J Cardiothorac Vasc Anesth，2011，25（6）：1119-1120.
[7] Ambrosio C，Leykin Y，Pellis T，et al. Endotracheal kinking of a double-lumen tube：a potential complication of inappropriate size tube selection [J]. Eur J Anaesthesiol，2011，28（8）：607-608.
[8] Brodsky JB，Lemmens HJ. Left double-lumen tubes：clinical experience with 1，170 patients [J]. J Cardiothorac Vasc Anesth，2003，17（3）：289-298.
[9] Bahk JH. Guidelines for determining the appropriateness of double-lumen endobronchial tube size [J]. Anesth Analg，2002，95（2）：501.
[10] Brodsky JB，Lemmens HJ. Tracheal width and left double-lumen tube size：a formula to estimate left-bronchial width [J]. J Clin Anesth，2005，17（4）：267-270.
[11] Ambrosio C，Leykin Y，Pellis T，et al. Endotracheal kinking of a double-lumen tube：a potential complication of inappropriate size tube selection [J]. Eur J Anaesthesiol，2011，28（8）：607-608.
[12] Slinger P. A view of and through double-lumen tubes [J]. J Cardiothorac Vasc Anesth，2003，17（3）：287-288.
[13] Zani G，Stefano M，Tommaso BF，et al. How clinical experience leads anesthetists in the choice of double-lumen tube size [J]. J Clin Anesth，2016，32：1-3.
[14] Ideris SS，Che HM，Abdul Rahman MR，et al. Selection of an appropriate left-sided double-lumen tube size for one-lung ventilation among Asians [J]. Ann Card Anaesth，2017，20（1）：28-32.
[15] Jain SV，Kollisch-Singule M，Satalin J，et al. The role of high airway pressure and dynamic strain on ventilator-induced lung injury in a heterogeneous acute lung injury model [J]. Intensive Care Med Exp，2017，5（1）：25.
[16] Nieman GF，Satalin J，Andrews P，et al. Personalizing mechanical ventilation according to physiologic parameters to stabilize alveoli and minimize ventilator induced lung injury（VILI） [J]. Intensive Care Med Exp，2017，5（1）：8.
[17] Zhang Y，Gao J，Wang CJ，et al. Low tidal volume ventilation?preconditioning ameliorates lipopolysaccharide-induced acute lung injury in rats [J]. Acta Anaesthesiol Scand，2016，60（6）：780-789.
[18] Cherpanath TG，Smeding L，Hirsch A，et al. Low tidal volume ventilation ameliorates left ventricular dysfunction in mechanically ventilated rats following LPS-induced lung injury [J]. BMC Anesthesiol，2015，15：140.
[19] Beitler JR，Ghafouri TB，Jinadasa SP，et al. Favorable Neurocognitive Outcome with Low Tidal Volume Ventilation after Cardiac Arrest [J]. Am J Respir Crit Care Med，2017，195（9）：1198-1206.
[20] 赵亚杰，曹江北，米卫东.肺保护性通气策略在围手术期的应用进展[J].临床麻醉学杂志，2016，32（12）：1229-1232.
[21] 王飞，唐鲁，高成杰.全麻手术中肺保护性通气策略研究进展[J].人民军医，2015，58（11）：1355-1356.
[22] 司啸辰.呼吸机系统定标误差对机械通气性能影响的分析及质量控制[J].中国医学装备，2016，13（6）：23-25．
[23] Cohen E. Double-lumen tube position should be confirmed by fiberoptic bronchoscopy [J]. Curr Opin Anaesthesiol，2004，17（1）：1-6. |
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