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LETTERS TO EDITOR
Year : 2019  |  Volume : 13  |  Issue : 4  |  Page : 388-389

‘Fibreoptic in Tracheal Lumen’ (FIT) technique: A novel real-time double-lumen tube placement technique with fiberoptic bronchoscope


Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Sector 32, Chandigarh, India

Correspondence Address:
Dr. Manpreet Singh
Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Sector 32, Chandigarh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/sja.SJA_821_18

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Date of Web Publication5-Sep-2019
 


How to cite this article:
Anand LK, Singh M, Singh J, Kapoor D. ‘Fibreoptic in Tracheal Lumen’ (FIT) technique: A novel real-time double-lumen tube placement technique with fiberoptic bronchoscope. Saudi J Anaesth 2019;13:388-9

How to cite this URL:
Anand LK, Singh M, Singh J, Kapoor D. ‘Fibreoptic in Tracheal Lumen’ (FIT) technique: A novel real-time double-lumen tube placement technique with fiberoptic bronchoscope. Saudi J Anaesth [serial online] 2019 [cited 2019 Nov 18];13:388-9. Available from: http://www.saudija.org/text.asp?2019/13/4/388/266014



Sir,

One-lung ventilation is often required in thoracic surgeries. Ventilation of one lung is usually accomplished with use of double-lumen tube (DLT). Insertion of DLT needs high expertise for high success rate. The correct DLT placement is important step for proper functioning and ventilation.[1] Placement of DLT poses challenges as it obstructs laryngoscopic view while insertion. This may be due to its preformed shape, large diameter, and extra length.[2],[3] Conventionally, two techniques are commonly used for placement of DLT; blind technique and other fiberoptic bronchoscope (FOB) guided.

Both the conventional techniques consist of several cumbersome steps, need high expertise and have drawbacks and malpositioning.[4],[5]

We, hereby, describe real-time visualization of DLT placement with FOB i.e., 'FIT technique' and it is as follows:

  1. After standard anesthesia induction technique, DLT is inserted through vocal cords with video laryngoscopy (VL) (preferably) or direct laryngoscopy (DL)
  2. The DLT is rotated 90° on its long axis toward the side where it is to be inserted (left side in case of left DLT and right side in case of right DLT). It is then advanced until tracheal lumen also enters larynx
  3. The tip of FOB is placed in tracheal lumen through tracheal port of DLT [Figure 1]
  4. The FOB is then advanced down the trachea to identify carina, the right and left main stem bronchi. Now, bronchial tip of DLT is advanced further under real-time visualization into the desired main bronchus
  5. Confirmation of DLT: The correct position of the DLT is confirmed with one of following methods:


    1. Air bubble method: After inflating bronchial cuff gently, observe appearance of small air bubble just above bronchial cuff provided some secretions are present in bronchial tree. This is seen through FOB placed in tracheal lumen
    2. Blue hue method: If there is no secretion, then on inflation of bronchial cuff it is observed that blue hue of bronchial cuff appears (easily seen through FOB placed in tracheal lumen).
    3. Now inflate the tracheal cuff and remove the FOB
Figure 1: Real-time visualization of double-lumen tube (DLT) placement with fiberoptic bronchoscope (FOB), (a) The FOB is advanced distal to DLT to identify the carina, right and left main stem bronchi. (b) Bronchial lumen of left DLT entering in left main bronchus. (c) Blue hue of the left bronchial cuff in left main stem bronchus distal to carina with air bubble. (d) Blue hue of right bronchial cuff in left main stem bronchus distal to carina. White arrows depicting the air bubble, while inflating the bronchial cuff. Blue arrows depicting blue hue of bronchial cuff in left (c) and right (d) main bronchus

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We have used this technique in 34 DLT cases (27 left, 7 right). There was no failure or any complication observed. A larger sample sized study is required to authenticate this further.

To conclude, real-time visualization of DLT placement (FIT Technique) with the FOB is faster, safer and definitive technique. Direct visualization of bronchial cuff inflation is an advanced definitive method that helps to confirm proper DLT position. On extensive search of internet literature, the authors could not find such method of DLT placement with FOB.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Haas CF, Eakin RM, Konkle MA, Blank R. Endotracheal tubes: Old and new. Respir Care 2014;59:933-52.  Back to cited text no. 1
    
2.
Brodsky JB. Lung separation and the difficult airway. Br J Anaesth 2009;103:i66-75.  Back to cited text no. 2
    
3.
Satya-Krishna R, Popat M. Insertion of the double lumen tube in the difficult airway. Anaesthesia 2006;61:896-8.  Back to cited text no. 3
    
4.
Alliaume B, Coddens J, Deloof T. Reliability of auscultation in positioning of double-lumen endobronchial tubes. Can J Anaesth 1992;39:687-90.  Back to cited text no. 4
    
5.
Smith GB, Hirsch NP, Ehrenwerth J. Placement of double-lumen endobronchial tubes: Correlation between clinical impressions and bronchoscopic findings. Br J Anaesth 1986;58:1317-20.  Back to cited text no. 5
    


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