Fiberoptic Bronchoscopy for Positioning Double-Lumen Tubes and Bronchial Blockers

Abstract

Flexible fiberoptic bronchoscopy is a diagnostic and therapeutic procedure of great value in the clinical practice of thoracic anesthesia. [1] The most common method to perform flexible fiberoptic bronchoscopy is with the use of a single-lumen endotracheal tube. Once the tube is advanced beyond the vocal cords and inside the trachea, the tip of the endotracheal tube should come to rest 3-4 cm above the tracheal carina. A Portex fiberoptic bronchoscope (SSL American, Inc. Norcross, Georgia USA) swivel adapter with a self-sealing valve is used to facilitate ventilation and manipulation of the bronchoscope at the same time. When using a large single-lumen endotracheal tube, an adult fiberoptic bronchoscope should be used (i.e. 4.1 mm inner diameter). Another alternative to perform fiberoptic bronchoscopy is with the use of a laryngeal mask airway (LMA). This technique allows visualization of the vocal cords and subglottic structures with lower resistance than a single-lumen endotracheal tube when the bronchoscope is inserted.