Lighted Stylet for Placement of a Double-Lumen Endobronchial Tube

To the Editor:

Recently, there has been an interesting discussion in Anesthesia & Analgesia about placing a double-lumen endobronchial tube when a difficult intubation is anticipated ^[1-3]. We used a lighted stylet in such a situation.

A 61-yr-old, 160-cm, 71-kg female scheduled for an elective lobectomy had full dentition, a Mallampati Class 3 airway, a thyromental distance of less than two finger breadths, and no history of anesthesia or surgery. After placing appropriate monitoring devices, we cut 2.5 cm off both lumina of a 37-Fr double-lumen endobronchial tube ^[4] so that the stylet would reach the end of the tube Figure 1. The stylet was lubricated and inserted into the bronchial lumen. Anesthesia was induced and the tube placed in the patient's oropharynx. Midline transtracheal illumination aided advancement of the tube into the trachea. Afterward, the stylet was removed, and the tube was rotated 90 degrees and advanced into the left mainstem bronchus. Auscultation confirmed proper placement. The case had no complications.

Figure 1: Lighted stylet inserted into the bronchial lumen of a double-lumen endobronchial tube off of which the ends have been cut (arrows).

The lighted-stylet method can be used in the presence of blood or secretions because, unlike bronchoscopy, it does not require direct visualization. It is less invasive than retrograde intubation, which can result in infection, hematoma, and pneumomediastinum ^[5]. The tube we used was easy to advance over the stylet and did not require rotation, perhaps because double-lumen tubes do not have beveled tips, as do single-lumen tubes, which often must be rotated so that the tip does not become caught in the laryngeal structures ^[6]. Shortening a double-lumen tube does not alter its structural integrity ^[4].

Mark A. Scanzillo, MD

Mark S. Shulman, MD

Department of Anesthesiology, St. Elizabeth's Medical Center of Boston, Tufts University School of Medicine, Boston, MA 02135