title: Endobronchial intubation in thoracic surgery: Which side should be preferred?
abstract: OBJECTIVE
  This study was undertaken to compare the clinical performance of right versus left double-lumen endotracheal tubes placed without using fiberoptic bronchoscopy in thoracic surgery operations.
  
  
  METHODS
  This was a retrospective review of patients who were operated on in our institution between January 2013 and February 2014. We analyzed clinical performance in terms of hypoxia, hypercapnia, and adequate deflation of the lungs with both left- and right-sided double-lumen endotracheal tubes.
  
  
  RESULTS
  There were 80 patients with a mean age of 53.74 ± 15.59 years. Right-sided double-lumen tubes were used in 33 patients, and left-sided double-lumen tubes were used in 47. Perioperative hypoxi (p < 0.05), hypercapnia (p < 0.01), and inadequate deflation of the lung (p < 0.001) were found more frequently with the use of right-sided double-lumen endotracheal tubes. Arterial blood gas analyses in the post-anesthesia care unit showed that high pCO2 (>45 mm Hg), low pH (<7.36), and high lactate levels (>4 mmol L(-1)) were more frequent with right-sided double-lumen endotracheal tubes (p < 0.001). The incidence of atelectasis was greater (p < 0.001) and the duration of hospital stay was longer (p = 0.02) with the use of right-sided double-lumen endotracheal tubes.
  
  
  CONCLUSIONS
  Right-sided double-lumen endotracheal tubes resulted in poorer clinical performance. Therefore, a left-sided double-lumen endotracheal tube should be preferred in thoracic surgery operations when an appropriate size of fiberoptic bronchoscope is not available.
authors.affiliation: Department of Thoracic Surgery, Ufuk University Faculty of Medicine, Ankara, Turkey tevfikkaplan@yahoo.com.
authors.forename: Tevfik
authors.initials: T
authors.lastname: Kaplan
authors.affiliation: Department of Anesthesiology and Reanimation, Ufuk University Faculty of Medicine, Ankara, Turkey.
authors.forename: Perihan
authors.initials: P
authors.lastname: Ekmekçi
authors.affiliation: Department of Anesthesiology and Reanimation, Ufuk University Faculty of Medicine, Ankara, Turkey.
authors.forename: Baturay Kansu
authors.initials: BK
authors.lastname: Kazbek
authors.affiliation: Department of Chest Diseases, Ufuk University Faculty of Medicine, Ankara, Turkey.
authors.forename: Nalan
authors.initials: N
authors.lastname: Ogan
authors.affiliation: Department of Statistics, Ufuk University Faculty of Arts and Sciences, Ankara, Turkey.
authors.forename: Aslıhan
authors.initials: A
authors.lastname: Alhan
authors.affiliation: Department of Thoracic Surgery, Ankara Numune Teaching and Research Hospital, Ankara, Turkey.
authors.forename: Bulent
authors.initials: B
authors.lastname: Koçer
authors.affiliation: Department of Thoracic Surgery, Ufuk University Faculty of Medicine, Ankara, Turkey.
authors.forename: Serdar
authors.initials: S
authors.lastname: Han
authors.affiliation: Department of Anesthesiology and Reanimation, Ufuk University Faculty of Medicine, Ankara, Turkey.
authors.forename: Filiz
authors.initials: F
authors.lastname: Tüzüner
mesh_terms: D000328:Adult; D000368:Aged; D001784:Blood Gas Analysis / Q000379:methods; D001999:Bronchoscopy / Q000295:instrumentation / Q000379:methods; D004867:Equipment Design; D005260:Female; D006801:Humans; D006935:Hypercapnia / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control; D000860:Hypoxia / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D008168:Lung / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000175:diagnosis / Q000517:prevention & control; D012189:Retrospective Studies; D019616:Thoracic Surgical Procedures / Q000379:methods*; D014421:Turkey
keywords: Anesthesia; Artificial; Bronchoscopes; Intratracheal; Intubation; Lung; Respiration; Thoracic surgical procedures