Güç entübasyonda yeni bir yöntem: Fiberoptik ve stile yardımlı çift lümenli tüp ile oral entübasyon (Olgu sunumu)

Abstract

In this article, a new orotracheal intubation technique involving the use of a double-lumen tube, flexible fiberoptic bronchoscope and a stylet, in an unexpected difficult intubation case is presented. A 43 years-old male patient was scheduled for elective thoracic surgery. After induction of anaesthesia and relaxation of the patient, endotracheal intubation was not achieved by direct laryngoscopy because of its unexpected difficult anatomical conditions. Then, conventional fiberoptic bronchoscope guided intubation was tried, but it was not possible to advance the fiberoptic because of the direct contact of it with the laryngeal mucosa. So it was decided to combine fiberoptic bronchoscope and the double-lumen tube with a stylet to direct them. A pediatric fiberoscope was inserted into the endobronchial part of the double-lumen tube and advanced until 1-2 mm of the distal end of the tube for prevention of the direct contact with the laryngeal mucosa. Stylet was placed into the endotracheal part of the tube to provide appropriate bend of the tube. The tip of the tube was bend to 75-80 degrees with the aid of the stylet. Then the tube was advanced from oropharynx to trachea under direct vision through fiberoptic bronchoscope inside the tube and endotracheal intubation was achieved successfully. At that moment the stylet was withdrawn and endobronchial intubation was completed under the guidance of the fiberoptic bronchoscope. We concluded that, the above mentioned technique may increase the success rate in unexpected difficult intubation cases requiring double lumen tube.