title: Efficacy of Supraglottic Airway for Preventing Lung Injury Associated with Coughing at Extubation after Pulmonary Lobectomy.
abstract: The use of double-lumen endobronchial tubes (DLTs) is necessary for differential lung ventilation during pulmonary lobectomy. However, when used with conventional extubation procedures, coughing is more likely and is associated with an increased risk for parenchymal air leak along the staple line and possible subsequent lung injury. We examined the prevalence of coughing-associated air leaks at extubation and the efficacy of using supraglottic airways (SGAs) to prevent air leaks with post-lobectomy extubation.
  
  
  
  This study included 150 patients with pulmonary emphysema diagnosed using preoperative computed tomography, who underwent pulmonary lobectomy between April 2010 and March 2015. The patients were chronologically enrolled in two groups: the DLT group (60 patients) from April 2010 to August 2012, and the SGA group (90 patients) from September 2012 to March 2015. (Note: the DLT group only included cases without air leak present just prior to extubation). Data were collected on specific patient characteristics and operative and postoperative factors.
  
  
  
  Coughing at extubation occurred in 15 (25.0 %) of 60 DLT patients, and parenchymal air leaks developed in 10 (66.7 %) of these 15. Comparison of groups revealed the SGA group was significantly lower for the following: patients with coughing at extubation (P < 0.001), coughing-associated air leaks at extubation (P < 0.001), air leaks >7 days (P = 0.006), reoperation due to air leaks (P = 0.013), and duration of chest tube drainage (P < 0.001).
  
  
  
  The SGA is effective for preventing air leaks associated with coughing during conventional DLT extubation in post-lobectomy patients.
authors.affiliation: Department of Thoracic Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan. hishiba.thsr@tmd.ac.jp.
authors.forename: Hironori
authors.initials: H
authors.lastname: Ishibashi
authors.affiliation: Department of Thoracic Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Kobayashi
authors.affiliation: Department of Thoracic Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
authors.forename: Chihiro
authors.initials: C
authors.lastname: Takasaki
authors.affiliation: Department of Anesthesiology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
authors.forename: Seiji
authors.initials: S
authors.lastname: Ishikawa
authors.affiliation: Department of Anesthesiology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Miura
authors.affiliation: Department of Anesthesiology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
authors.forename: Koshi
authors.initials: K
authors.lastname: Makita
authors.affiliation: Department of Thoracic Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Okubo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000388:Air; D060666:Airway Extubation / Q000009:adverse effects*; D057868:Anastomotic Leak / Q000209:etiology; D015505:Chest Tubes; D003371:Cough / Q000209:etiology*; D004322:Drainage; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation*; D055370:Lung Injury / Q000209:etiology / Q000517:prevention & control*; D008175:Lung Neoplasms / Q000150:complications / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy; D011184:Postoperative Period; D011656:Pulmonary Emphysema / Q000150:complications; D012086:Reoperation