This Month in Anesthesiology

Most previous studies comparing lung isolation methods and devices have been performed by anesthesiologists who had extensive experience in thoracic anesthesia. With the increasing demand for one-lung ventilation, it is also important to define which device can be used most effectively by occasional users. In this issue, Campos et al. report on a study comparing the success rates of three different lung isolation methods used by a group of anesthesiologists not practiced in thoracic anesthesia. Anesthesiologists enrolled in the study were required to have some familiarity with the three lung isolation devices (a double-lumen endotracheal tube; a torque control blocker; and an endobronchial blocker with a spherical-shaped balloon) but not to have performed a lung-isolation procedure more than twice in the preceding month. Each was given a standardized tutorial on the three devices the day before the study. Patients aged 21–82 yr undergoing elective thoracic or esophageal surgical procedures were included in the study and assigned to one of the three device management groups. Under supervision of the faculty anesthesiologist responsible for the care of all the patients, participating anesthesiologists attempted placement of the lung devices. Time to complete placement, number of reinsertions of the fiberoptic bronchoscope during placement, and malpositions were all recorded. In addition, the time required for the experienced thoracic anesthesiologist to correctly reposition the device was also recorded. The failure rate to position their assigned device was 39% among faculty and 36% among senior residents. The failure rate did not differ among the three devices. The median time to complete placement procedures was 6.1 min for the double-lumen tube, 6.7 min for the torque control blocker, and 8.6 min for the wire-guided endobronchial blocker. After device malpositions were identified, it took 1 min or less for the investigating anesthesiologist to achieve optimal position. The most critical factor in successful placement was the anesthesiologist’s knowledge of endoscopic bronchial anatomy.