title: Replacing a double-lumen tube with a single-lumen tube or a laryngeal mask airway device to reduce coughing at emergence after thoracic surgery: a randomized controlled single-blind trial.
abstract: BACKGROUND
  Coughing episodes occur frequently at extubation after thoracic surgery, and this may be due in part to the double-lumen tube (DLT). In this study, the DLT was replaced with either a single-lumen endotracheal tube (ETT) or a laryngeal mask airway (LMA) device or left in place, and the incidence of coughing at emergence was compared between the three groups.
  
  
  METHODS
  Fifty-eight adults scheduled for thoracic surgery with a DLT were included. Exclusion criteria were an anticipated difficult airway, obesity, and contraindication to the use of an LMA ProSeal™ (LMA-P). After surgery but before emergence, patients were randomized to having the DLT (1) removed and replaced by an LMA-P (LMA-P Group), (2) removed and replaced by an ETT (ETT Group), or (3) left in place (DLT Group). The primary outcome was the number of coughing episodes at extubation.
  
  
  RESULTS
  Among 184 patients screened, 124 did not meet inclusion criteria, and two patients, both in the ETT Group, were excluded after randomization, leaving 20, 18, and 20 patients in the LMA-P, ETT, and DLT Groups, respectively. There were fewer coughing episodes (median [quartiles]) in the LMA-P Group than in the DLT Group (0[0-1] vs 2[1-3], respectively; P = 0.01). In the DLT Group, 90% of patients coughed at least once. This incidence was not significantly different in the ETT Group (83%; P = 0.222) but was significantly reduced in the LMA-P Group (35%; P < 0.001). No patient had oxygen desaturation during airway exchange or at extubation. The incidence and severity of hoarseness and sore throat were similar in all groups.
  
  
  CONCLUSIONS
  Coughing at extubation after thoracic surgery can be reduced if the DLT is replaced by an LMA-P before emergence. The number of patients in this trial was too small to evaluate the risks associated with exchanging the airway device. This trial was registered at ClinicalTrials.gov: NCT00925613.
authors.affiliation: Département d'anesthésiologie, Université de Montréal, Hôpital Maisonneuve-Rosemont, 5415 boulevard de l'Assomption, Montréal, QC, H1T 2M4, Canada, i.tanoubi@umontreal.ca.
authors.forename: Issam
authors.initials: I
authors.lastname: Tanoubi
authors.forename: Joanna Ng Man
authors.initials: JN
authors.lastname: Sun
authors.forename: Pierre
authors.initials: P
authors.lastname: Drolet
authors.forename: Louis-Philippe
authors.initials: LP
authors.lastname: Fortier
authors.forename: François
authors.initials: F
authors.lastname: Donati
mesh_terms: D000328:Adult; D000368:Aged; D060666:Airway Extubation; D003371:Cough / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D015994:Incidence; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D017214:Laryngeal Masks / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D010612:Pharyngitis / Q000453:epidemiology / Q000209:etiology; D016037:Single-Blind Method; D019616:Thoracic Surgical Procedures / Q000379:methods*