The clinical use of right-sided double-lumen tubes

Excerpt

Right-sided double-lumen tubes (DLTs) have a bad reputation. Many experts in the field of thoracic anesthesia regard them as being difficult to position, having a small margin of safety for correct placement, and being prone to intraoperative malpositioning.1 However, in a randomized prospective study, Campos et al. compared the use of right vs left DLTs in two groups of 20 patients having left thoracotomies.2 In this small study, there were no significant differences between the two types of DLTs with respect to the relevant aspects of clinical performance, including the time for left lung collapse and the incidence of inadvertent right upper lobe collapse. There was a tendency for right-sided tubes to become malpositioned intraoperatively, but in all cases this difficulty was corrected easily by fibreoptic bronchoscopy. In a more recent retrospective report, the anesthetic records of 961 thoracic procedures were examined at one teaching institution where the usual practice was to use a DLT contralateral to the side of surgery, i.e., a right-sided tube for left-sided surgery.3 There were no differences in the incidences of hypoxemia, hypercarbia, or high airway pressures between patients managed with left or right DLTs. The current sales of DLTs in North America show a 10:1 preference for left- vs right-sided tubes (personal communication with Covidien, Mansfield, MA, USA), suggesting that the majority of anesthesiologists tend to use left DLTs whenever possible. Given the evidence that right DLTs may function as well as left DLTs, and in view of the fact that it is necessary to use a right DLT in certain select cases,4 perhaps it is time to reconsider their use for routine airway management in thoracic surgery. …