Audit of double-lumen endobronchial intubation.
BACKGROUND: Many technical variations are possible in the placing and management of a double-lumen tube (DLT). We surveyed our practice to relate these variations to the course of the anaesthetic. METHODS: We used a questionnaire to obtain details of technique in 506 consecutive double lumen intubations. The details were related to the incidence of secretions, tube displacement, and decreases of oxygen saturation (<88%) during one lung anaesthesia (OLA). RESULTS: Robertshaw tubes were used for 482 of the 506 intubations. During OLA there were 48 instances of desaturation (<88%), 19 cases of upper lobe obstruction, 15 of carinal obstruction, 16 of isolation failure, eight of excessive secretions (none of whom had received an antisialogogue; P<0.01) and 12 miscellaneous events. The experience of the anaesthetist or use of a fibre-optic bronchoscope did not affect these events. Air was of no advantage as a maintenance gas. Atropine 400-600 micro g appeared to prevent desaturation on OLA (P<0.05) but glycopyrrolate 200 micro g did not. CONCLUSION: Most factors had little effect on the progress of the anaesthetic, but an antimuscarinic usefully reduced secretions, and atropine (but not glycopyrrolate) was associated with less desaturation during OLA.