Pitfalls of Double Lumen Endotracheal Tube in Prone Position During a Thoracoscopic and Laparoscopic Assisted Esophagectomy (TLAE) : A Sabah Experience

  • Ming Kai Tan Department of Anaesthesia and Critical Care, Queen Elizabeth Hospital, Kota Kinabalu, Sabah, Malaysia
  • Tat Boon Yeap Medicine Based Department, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia
  • Shanmuganathan Sakuntala Dewi Department of Anaesthesia and Critical Care, Queen Elizabeth Hospital, Kota Kinabalu, Sabah, Malaysia

Abstract

This case report is about a young gentleman who was diagnosed with advanced achalasia cardia with mega-esophagus and underwent an elective thoracoscopic and laparoscopic assisted esophagectomy (TLAE) in prone position. We highlight the challenges of maintaining correct placement of double lumen tube (DLT) while positioning the patient into prone position, as well as the use of fiberoptic bronchoscope (FOB) in troubleshooting dislodgement of DLT while pronated.

Author Biographies

Ming Kai Tan, Department of Anaesthesia and Critical Care, Queen Elizabeth Hospital, Kota Kinabalu, Sabah, Malaysia
Senior Registrar Anaesthesia and Critical Care Unit Queen Elizabeth Hospital Kota Kinabalu Sabah
Tat Boon Yeap, Medicine Based Department, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia
Consultant Anaesthesiologist Medicine Based Discipline Department Faculty of Medicine and Health Sciences Universiti Malaysia Sabah Kota Kinabalu Sabah
Shanmuganathan Sakuntala Dewi, Department of Anaesthesia and Critical Care, Queen Elizabeth Hospital, Kota Kinabalu, Sabah, Malaysia
Consultant Anaesthesiologist Anaesthesia and Critical Care Unit Queen Elizabeth Hospital Kota Kinabalu Sabah

References

Inoue S, Nishimine N, Kitaguchi K, Furuya H, Taniguchi S. Double lumen tube location predicts tube malposition and hypoxemia during one lung ventilation. Br J Anaesth 2004; 92: 195–201

Uwe Klein, Waheedullah Karzai, Frank Bloos, Mathias Wohlfarth, Reiner Gottschall, Harald Fritz, Michael Gugel, Albrecht Seifert; Role of Fiberoptic Bronchoscopy in Conjunction with the Use of Double-lumen Tubes for Thoracic Anesthesia : A Prospective Study. Anesthesiology 1998;88(2):346-350.

Smith GB, Hirsch NP, Ehrenwerth J: Placement of double-lumen endobronchial tubes. Correlation between clinical impressions and bronchoscopic findings. Br J Anaesth 1986; 58:1317-20.

Schottke-Hennings H, Klippe HJ, Schmieding B: Die Fiberbronchoskopie als Hilfsmittel zur Plazierung und Uberwachung von Doppellmentuben in der Thoraxanasthesie. [Fiber bronchoscopy as an aid in placing and monitoring double lumen tubes in thoracic anesthesia.] Anaesth Intensivther Notfallmed 1989; 24:327-33.

Grum DF, Porembka D: Misconceptions regarding double-lumen tubes and bronchoscopy [letter]. Anesthesiology 1988; 68:826-7.

Conacher ID, Herrema IH, Batchelor AM: Robertshaw double lumen tubes: A reappraisal thirty years on. Anaesth Intensive Care 1994; 22:179-83.

Slinger PD. Fiberoptic bronchoscopic positioning of double-lumen tubes. J Cardiothorac Anesth 1989; 3: 486–96

Published
2019-12-21