Double lumen tubes

Advantages

Can perform one-lung ventilation

Create a quiet surgical field along with better surgical visualization

Specifics

One lumen reaches the mainstem bronchus - blue cuff

One lumen ends in the - cuff

The distance from the carinal bifurcation to the left and right bronchus are

• Left = 4-5 cm
• Right = 1.5-2 cm

Sizes

• Left 41, 39, 37, 35, 28, 26
• Right 41, 39, 37, 35

Female

 <160 cm size 35

 >160 cm size 37

Male

<175 cm size 37/39

>175 cm size 39/41

For both, have sizes above and below

Depth of insertion - 29 cm +/- 1 cm for every 10 cm of height above or below 170 cm

Placement

Lubricate the distal end, including the cuff. Use a MAC blade, insert until the black ring passes through the cords, then remove the stylet. Rotate 90 degrees towards the bronchus you want to intubate.

Tracheal cuff 5-10mL of air, bronchial 1-2 mL of air.

Check placement - both auscultation and fiber optically

• Bilateral breath sounds with both cuffs inflated
• Clamp the tracheal side and open it to air - should only have breath sounds on the bronchial side
• Close the port and unclamp
• Repeat with the bronchial side - should only have breath sounds on the tracheal side

Ways to improve Hypoxic Pulmonary Vasoconstriction (HPV)

Narcotic Anesthesia

CPAP 5-10 cm to the non-ventilated lung

• Improve oxygenation

PEEP - 5-10 cm to the ventilated lung

• Stents airways open

Volatile agent <1 MAC

Early ligation of pulmonary artery - pneumonectomy only

Periodic inflation of non-ventilated lung

Insufflation of oxygen into the collapsed lung

Reduce vasodilator usage

• Cardene is the best option if needed