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Selective Left Endobronchial Intubation in Paediatric Cases: Lesson Learnt Using Single Lumen Tube

Basant Chaurasia, Associate Professor, Anaesthesia, CCM Medical College, Durg, Bhilai, Chhattisgarh 490024, India. , Chaurasia Basant1 , Verma S.R.2

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Indian Journal of Anesthesia and Analgesia 5(10):p 1620-1622, Oct 2018. | DOI: http://dx.doi.org/10.21088/ijaa.2349.8471.51018.6

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Abstract

  Background: Selective left endobronchial intubation in right thoracoscopy is technically demanding. We are presenting our mid term experience of selective left bronchus intubation using the previously published maneuver with single lumen endotracheal tube. Methods: 135 consecutive children below 12 years underwent right thoracoscopy from June 2014­Jan 2017. Endotracheal tube was kept in the freezer for 60 seconds to provide slight stiffness. Selective left bronchial intubation was done using neck extension, head tilt towards the right and left chest elevation maneuver. The tip of tube was rotated by 90° after 9cm to guide it towards left main bronchus. Maximum of three attempts were tried and ET tube kept in the trachea if selective intubation was not possible. Results: Selective left bronchus intubation could be done in 131 (97.03%). Follow­up ranged from 3 to 12 months. All cases were asymptomatic at last follow up. Selective intubation could be done on first attempt in 126 (93.33%), second attempt in 3 (2.22%), third attempt in 2 (1.48%). In 4 (2.96%) cases left endobronchial intubation could not be achieved. Mean operating time was 1.30 hours (Range: 1.00­2.30 hours). There were 115 empyeama (tubercular­13), 18 hydratid cysts and 2 esophageal duplication cyst. The intercostal drain was kept for a mean period of 3 days (Range: 2­4 days). All the cases were kept nil orally for 6 hours and
discharged at a mean duration of 5 days (Range 4­6 days). Conclusions: Thoracoscopic procedures for right sided pathology could safely and easily be performed using this novel technique.

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DOI: http://dx.doi.org/10.21088/ijaa.2349.8471.51018.6

Keywords

Selective Left Endobronchial Intubation; Thoracoscopy; Empyema.

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