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Double-lumen tubes—The final word?
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LETTERS TO THE EDITOR
ACKNOWLEDGMENT
The author IS grateful to Dr I McLellan, Chnlcal Chairman of Anaesthesia and Critical Care, The Glenfield Hospital NHS Trust, Leicester, LE3 9QP, UK, for supervising the preparahon of the manuscript REFERENCES
1 English ICW, Frew RM, PIgott JF, et al Percutaneous cathetensation of the internal jugular vein. Anaesthesia 24 521531, 1969 2 Hug CC Jr. Monitoring, in Miller RD (ed) Anesthesia New York, NY, Churchill Livingstone, 1986, pp 438-442 3 Ream AK, Fowles RE, JamIeson S' Cardiac transplantation, in Kaplan JA (ed): Cardiac Anesthesia, vol 2 Orlando, FL, Grune & Stratton, 1987, pp 881-890
4 MIttO P, Baranky A, Spath P, et al Central venous catheterlsation in infants and children with congenital heart &sease J Cardlothor Anesth 3:53, 1989 (suppl 1) 5 Kaplan JA, Miller ED Internal jugular vein catheterlzauon Anesthesiol Rev 21:1976.21-23
Double-Lumen TubesmThe Final Word? To the Edttor. The controversy surrounding placement of the double-lumen endobronchlal tubes overlooks some very simple principles: 1. Use a Carlens' endobronchial tube (Rusch, Germany). For those readers unfamiliar with this, it is a double-lumen tube designed so that the endobronchlal part is intended to enter the left main bronchus. There is a carinal hook to prevent the tube being pushed down too far. There is a very &stinctive feel when the hook is engaged on the carlna The other lumen is opposite, but not in, the right mare bronchus. Once the tube has been passed in the accepted m a n n e r and the endobronchial part is in the left bronchus, as verified by visualization and auscultation, there is httle need for fiberoptics. This tube is suitable for all intrathoracic procedures with the possible exception of a left pneumonectomy. 2. For a left pneumonectomy, a single-lumen right endobronchial tube (Gordon Green; Rusch, Germany) is used. There is a "'hook" on this tube as well that serves the same purpose as it does with the "Carlens." There are occasions where the right upper lobe bronchus comes directly offthe trachea In this situation, auscultation at the apex of the right upper lobe wall reveal an absence of air entry when the endobronchlal balloon has been inflated. All other machinations are irrelevant and there is rarely a need for fiber-optic verification. There is certainly no justifi-
cation for mandating at to be the standard of care whenever double-lumen tubes are used. Perhaps those corresponding on this subject have not had sufficient "hands-on" experience in thoracic anesthesia
John F. Vdjoen, MBChB(UCT), FFARCS(Eng) Professor of Anaesthesia University of Cape T o w n / G r o o t e Schuur Hospital Cape, South Africa
LETTERS TO THE EDITOR
ACKNOWLEDGMENT
The author IS grateful to Dr I McLellan, Chnlcal Chairman of Anaesthesia and Critical Care, The Glenfield Hospital NHS Trust, Leicester, LE3 9QP, UK, for supervising the preparahon of the manuscript REFERENCES
1 English ICW, Frew RM, PIgott JF, et al Percutaneous cathetensation of the internal jugular vein. Anaesthesia 24 521531, 1969 2 Hug CC Jr. Monitoring, in Miller RD (ed) Anesthesia New York, NY, Churchill Livingstone, 1986, pp 438-442 3 Ream AK, Fowles RE, JamIeson S' Cardiac transplantation, in Kaplan JA (ed): Cardiac Anesthesia, vol 2 Orlando, FL, Grune & Stratton, 1987, pp 881-890
4 MIttO P, Baranky A, Spath P, et al Central venous catheterlsation in infants and children with congenital heart &sease J Cardlothor Anesth 3:53, 1989 (suppl 1) 5 Kaplan JA, Miller ED Internal jugular vein catheterlzauon Anesthesiol Rev 21:1976.21-23
Double-Lumen TubesmThe Final Word? To the Edttor. The controversy surrounding placement of the double-lumen endobronchlal tubes overlooks some very simple principles: 1. Use a Carlens' endobronchial tube (Rusch, Germany). For those readers unfamiliar with this, it is a double-lumen tube designed so that the endobronchlal part is intended to enter the left main bronchus. There is a carinal hook to prevent the tube being pushed down too far. There is a very &stinctive feel when the hook is engaged on the carlna The other lumen is opposite, but not in, the right mare bronchus. Once the tube has been passed in the accepted m a n n e r and the endobronchial part is in the left bronchus, as verified by visualization and auscultation, there is httle need for fiberoptics. This tube is suitable for all intrathoracic procedures with the possible exception of a left pneumonectomy. 2. For a left pneumonectomy, a single-lumen right endobronchial tube (Gordon Green; Rusch, Germany) is used. There is a "'hook" on this tube as well that serves the same purpose as it does with the "Carlens." There are occasions where the right upper lobe bronchus comes directly offthe trachea In this situation, auscultation at the apex of the right upper lobe wall reveal an absence of air entry when the endobronchlal balloon has been inflated. All other machinations are irrelevant and there is rarely a need for fiber-optic verification. There is certainly no justifi-
cation for mandating at to be the standard of care whenever double-lumen tubes are used. Perhaps those corresponding on this subject have not had sufficient "hands-on" experience in thoracic anesthesia
John F. Vdjoen, MBChB(UCT), FFARCS(Eng) Professor of Anaesthesia University of Cape T o w n / G r o o t e Schuur Hospital Cape, South Africa