Smith CE, Davenport D, Morscher A: Exchange of a Double Lumen Endobronchial Tube Using Fiber-optic Laryngoscopy (Wuscope) in a Difficult Intubation Patient. J Clin Anesthesia 2006;18:398-399
Replacement of a double-lumen endobronchial tube (DLT) with a single- lumen endotracheal tube (ETT) may be hazardous after thoracic surgery, especially if the patients' trachea was difficult to intubate initially.1 We describe the use of the WuScope (Achi Corporation, San Jose, CA) to facilitate tube exchange in a patient with thick secretions, decreased head extension and reduced mouth opening. A 45 yo male was admitted with dyspnea and chest pain. Computed tomography showed a large multiloculated right sided empyema with associated volume loss in the right lower lobe and a diffuse infiltrate in the left lung. A CT guided chest tube was placed. The patient was taken to the operating room for right thoracoscopy, drainage of empyema, and decortication.
Anesthesia was induced with propofol, fentanyl, and rocuronium. Direct laryngoscopy revealed a grade 3 view. A fiberoptic bronchoscope was required to place the ETT. A 37 Fr left DLT was then inserted with substantial difficulty by way of passing the fiberoptic scope alongside the existing ETT. After completion of surgery, the patient required mechanical ventilation.
The WuScope was introduced into the patient's mouth at the midline. The handle was rotated towards the operator and the blade advanced until the epiglottis and larynx were seen (Grade 1 view). A suction catheter inside the ETT was used to remove the thick secretions and to align the ETT with the glottis. At this point a second operator removed the DLT while the new ETT was advanced over the suction catheter, through the vocal cords, and into the trachea. The entire tube exchange process took 15 seconds. The exchange sequence was continuously displayed on a color video monitor. The patient was transferred to the ICU for 24 hours, and was discharged home 4 days later with one month of antibiotics and pain medication.
Advantages of the WuScope include oropharyngeal airway shaped blade to allow visualization of the laryngeal aperture without the need for head extension, handle-to-blade angle of 110 degrees which allows easy placement into the mouth, tubular blade structure which protects the fiberscope from secretions, blood, and redundant soft tissue, and built-in passageway through which the ETT can be advanced. 2 At least 20 mm of mouth opening is necessary to insert the rigid blades. Although other techniques for DLT tube exchange are available such as airway exchange catheters, the WuScope was used because it was readily available and considerable experience had already been achieved with this technique.
References
1. Cooper RM. Extubation and changing endotracheal tubes. In: Benumof JL (Ed.) Airway Management. St Louis: Mosby, 1996: 864-85.
2. Smith CE, Sidhu TS, Lever J, Pinchak AB. The complexity of tracheal intubation using rigid fiberoptic laryngoscopy (Wuscope). Anesth Analg 1999;89:236-9
Replacement of a double-lumen endobronchial tube (DLT) with a single- lumen endotracheal tube (ETT) may be hazardous after thoracic surgery, especially if the patients' trachea was difficult to intubate initially.1 We describe the use of the WuScope (Achi Corporation, San Jose, CA) to facilitate tube exchange in a patient with thick secretions, decreased head extension and reduced mouth opening. A 45 yo male was admitted with dyspnea and chest pain. Computed tomography showed a large multiloculated right sided empyema with associated volume loss in the right lower lobe and a diffuse infiltrate in the left lung. A CT guided chest tube was placed. The patient was taken to the operating room for right thoracoscopy, drainage of empyema, and decortication.
Anesthesia was induced with propofol, fentanyl, and rocuronium. Direct laryngoscopy revealed a grade 3 view. A fiberoptic bronchoscope was required to place the ETT. A 37 Fr left DLT was then inserted with substantial difficulty by way of passing the fiberoptic scope alongside the existing ETT. After completion of surgery, the patient required mechanical ventilation.
The WuScope was introduced into the patient's mouth at the midline. The handle was rotated towards the operator and the blade advanced until the epiglottis and larynx were seen (Grade 1 view). A suction catheter inside the ETT was used to remove the thick secretions and to align the ETT with the glottis. At this point a second operator removed the DLT while the new ETT was advanced over the suction catheter, through the vocal cords, and into the trachea. The entire tube exchange process took 15 seconds. The exchange sequence was continuously displayed on a color video monitor. The patient was transferred to the ICU for 24 hours, and was discharged home 4 days later with one month of antibiotics and pain medication.
Advantages of the WuScope include oropharyngeal airway shaped blade to allow visualization of the laryngeal aperture without the need for head extension, handle-to-blade angle of 110 degrees which allows easy placement into the mouth, tubular blade structure which protects the fiberscope from secretions, blood, and redundant soft tissue, and built-in passageway through which the ETT can be advanced. 2 At least 20 mm of mouth opening is necessary to insert the rigid blades. Although other techniques for DLT tube exchange are available such as airway exchange catheters, the WuScope was used because it was readily available and considerable experience had already been achieved with this technique.
References
1. Cooper RM. Extubation and changing endotracheal tubes. In: Benumof JL (Ed.) Airway Management. St Louis: Mosby, 1996: 864-85.
2. Smith CE, Sidhu TS, Lever J, Pinchak AB. The complexity of tracheal intubation using rigid fiberoptic laryngoscopy (Wuscope). Anesth Analg 1999;89:236-9