Anesthetic principles of airway management and intubation, double lumen tubes
Advanced Thoracic Surgery, Akademisyen Kitabevi, ss.41-44, 2021
- Yayın Türü: Kitapta Bölüm / Araştırma Kitabı
- Basım Tarihi: 2021
- Yayınevi: Akademisyen Kitabevi
- Sayfa Sayıları: ss.41-44
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
In this section, the principles of anesthesia management for thoracic surgery focusing on airway management and selective double-lumen tube ventilation are discussed. Preoperative airway assessment includes evaluating variables such as Mallampati class, interincisor distance, sternomental and thyromental distance, mandibular protrusion, and neck hyperextension. Ultrasonography can be used for purposes such as determining tracheal tube size, confirming tracheal tube placement, identifying the cricothyroid membrane, or predicting post-extubation stridor. Assessing the anatomical airway integrity and respiratory capacities of patients requiring one-lung ventilation provides appropriate preparation for anesthesia management. Methods used for one-lung ventilation include double-lumen endobronchial tubes (DLT), bronchial blockers, and placement of a single-lumen tube. DLTs have advantages over bronchial blockers, such as ease of placement, rapid isolation, low cost, and the ability to perform bilateral lung examination with flexible bronchoscopy. However, the increased use of DLTs also comes with disadvantages such as increased risk of airway trauma, hoarseness, and throat pain. While DLT position is traditionally assessed by auscultation, fiberoptic bronchoscopy should be used as the gold standard. Misplacement of DLTs is the most common cause of intraoperative hypoxia during one-lung ventilation. Placement of DLTs is more challenging compared to single-lumen tube placement. Therefore, videolaryngoscopes are frequently used for pulmonary isolation in thoracic surgery. The American Society of Anesthesiologists (ASA) recommends awake tracheal intubation.