Korean J Anesthesiol.  2023 Aug;76(4):300-306. 10.4097/kja.22649.

Comparison of fiberoptic bronchoscopic intubation using silicone and polyvinyl chloride double-lumen tubes

• Kang S
• Chae YJ
• Kim DH
• Kim TG
• Yoo JY

• KMID: 2544549
• DOI: http://doi.org/10.4097/kja.22649

Abstract

Background
Direct insertion of a double-lumen tube (DLT) using a flexible fiberoptic bronchoscope (FOB) is an option for DLT intubation. The difficult process of fiberoptic intubation is that the different properties of polyvinyl chloride and silicone DLTs may affect railroading differently. Therefore, we aimed to compare intubation using polyvinyl chloride and silicone DLTs over an FOB.
Methods
Patients aged 19–75 years who required one-lung ventilation under general anesthesia were enrolled in this study. After induction of anesthesia, the anesthesiologist intubated the DLT using FOB. The primary outcome was the difficulty of railroading over the flexible FOB scaled into five grades (I, II-1, II-2, III, and IV). Additionally, the intubation time and mucosal damage were recorded.
Results
A total of 46 patients participated in this study, 23 each in the silicone and polyvinyl groups. The difficulty of railroading over the FOB was significantly different between the two groups (P < 0.001). In the silicone group, the grades of difficulty in railroading were limited to I and II-1; 20 patients (87%) presented no difficulty in advancing the tube. In contrast, in the polyvinyl group, 13 patients (57%) had scores of II-2 and III. Both the intubation time and mucosal damage were significantly better in the silicone group than in the polyvinyl group.
Conclusions
Intubation using a silicone DLT over an FOB was easier and faster than that with a polyvinyl chloride DLT with lesser trauma around the glottis.

Keyword

Airway management; Bronchoscope; Endotracheal intubation; One-lung ventilation; Polyvinyl chloride; Silicone; Thoracic surgery