title: A randomized trial to assess the utility of preintubation adult fiberoptic bronchoscope assessment in patients for thoracic surgery requiring one-lung ventilation.
abstract: BACKGROUND
  Confirmation of placement of Double lumen endobronchial tubes (DLETT) and bronchial blockers (BBs) with the pediatric fiberoptic bronchoscope (FOB) is the most preferred practice worldwide. Most centers possess standard adult FOBs, some, particularly in developing countries might not have access to the pediatric-sized devices. We have evaluated the role of preintubation airway assessment using the former, measuring the distance from the incisors to the carina and from carina to the left and right upper lobe bronchus in deciding the depth of insertion of the lung isolation device.
  
  
  METHODS
  The study was a randomized, controlled, double-blind trial consisting of 84 patients (all >18 years) undergoing thoracic surgery over a 12-month period. In the study group (n = 38), measurements obtained during FOB with the adult bronchoscope decided the depth of insertion of the lung isolation device. In the control group (n = 46), DLETTs and BBs were placed blindly followed by clinical confirmation by auscultation. Selection of the type and size of the lung isolation device was at the discretion of the anesthesiologist conducting the case. In all cases, pediatric FOB was used to confirm accurate placement of devices.
  
  
  RESULTS
  Of 84 patients (DLETT used in 76 patients; BB used in 8 patients), preintubation airway measurements significantly improved the success rate of optimal placement of lung isolation device from 25% (11/44) to 50% (18/36) (P = 0.04). Our incidence of failed device placement at initial insertion was 4.7% (4/84). Incidence of malposition was 10% (8/80) with 4 cases in each group. The incidence of suboptimal placement was lower in the study group at 38.9% (14/36) versus 65.9% (29/44).
  
  
  CONCLUSIONS
  Preintubation airway measurements with the adult FOB reduces airway manipulations and improves the success rate of optimal placement of DLETT and BB.
authors.affiliation: Department of Anesthesiology, Tata Memorial Centre, Mumbai, Maharashtra, India.
authors.forename: Nayana
authors.initials: N
authors.lastname: Amin
authors.forename: Pritee
authors.initials: P
authors.lastname: Tarwade
authors.forename: Madhavi
authors.initials: M
authors.lastname: Shetmahajan
authors.forename: C S
authors.initials: CS
authors.lastname: Pramesh
authors.forename: Sabita
authors.initials: S
authors.lastname: Jiwnani
authors.forename: Abhishek
authors.initials: A
authors.lastname: Mahajan
authors.forename: Nilendu
authors.initials: N
authors.lastname: Purandare
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D058109:Airway Management / Q000379:methods; D001314:Auscultation; D020680:Bronchoscopes; D001999:Bronchoscopy / Q000379:methods*; D004311:Double-Blind Method; D005260:Female; D005336:Fiber Optic Technology; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods*; D008297:Male; D008875:Middle Aged; D061810:One-Lung Ventilation / Q000379:methods*; D019616:Thoracic Surgical Procedures / Q000379:methods*; D055815:Young Adult