Effects Of One Lung Ventilation With Non-surgical Side Double Lumen Endobronchial Intubation During Video-assisted Thoracoscopic Surgery

Objective: Double-lumen endobronchial tubes(DLTs)intubation is the common technique and widely used to conduct lung isolation.The selection of the DLTs always complies with principle of "left better than right" during thoracic surgery throughout the world.This means that whether it is right thoracic surgery or left thoracic surgery,it is better to choose the left DLTs.Nowdays,with the improvement of intubation equipment and technology,especially the emergence of fiberbronchoscopic,the problem in placement of right DLTs is resolved partly.Thus whether this traditional concept has clinical advantage is controversial.In addition clinical practice indicates that there is a high risk of intermitte airway high pressure and airway obstruction in the left DLTs intubation for left thoracoscopic surgery,even causing hypoventilation and hypoxemia if serious.This is because the end of airway is inclined(about 45 angle)and near carinal,it is possible to be attached to the tracheal wall when pulled or pulled.This study aimed to explore the effect of on lung ventilation with non-surgical side double lumen endobronchial intubation during video-assisted thoracoscopic surgery by comparing the risk of intermittent high airway pressure and hypoxemia with non-surgical and surgical side DLTs intubation,in order to provide the basis for clinical application of DLTs.Methods: Ninety patients,ASA I-II,aged 40-70 years old,scheduled one lung ventilation during thoracoscopic surgery,were included.Patients with severe systemic diseases,obvious tracheal and bronchial injury,tracheal or bronchial abnormalities bychest-X and CT examination,history of bronchial asthma or high airway reaction were excluded.Patients were randomly divided into three groups(30 patients in each group),Group A: left DLTs intubation for left thoracoscopic surgery;Group B: left DLTs intubation for right thoracoscopic surgery;Group C: right DLTs intubation for left thoracoscopic surgery.Main outcomes included number of DLTs intubation,number and time of FOB placement before and after lateral position,incidence of intermittent airway high pressure and hypoxemia,lung isolation satisfaction and DLTs related complications,and these all were recorded.Results: There was no significant difference in gender,age,weight,height and the size of DLTs in the three groups(P>0.05);In the respect of intubation and placement of DLTs,there was no significant difference in the number and time of intubation,the depth of intubation,and time of FOB placement before and after lateral position in the three groups(P>0.05);There was also difference in placement frequency and time of FOB during surgery among three groups,both Group B and C were less than group A(P<0.05);For risk of airway high pressure and hypoxemia,Group B and C were lower than Group A,but both were higher than Group A in lung isolation satisfaction(P<0.05).In addition,patients in three groups has no difference in the risk of the postoperative sore throat(P>0.05).Conclusion: DLTs intubation in non-surgical side could reduce the risk of intraoperative intermittent airway high pressure and hypoxemia,and increase lung isolation satisfaction for VATS.DLTs intubation in non-surgical side for thoracoscopic surgery has better effects and should be recommended to widely use in clinical practice.