7. Awake Double Lumen Intubation–Renewed Interest

Madhavi Gaddam, Subhakar Kandi

ABSTRACT

Background & Purpose of the study: Initially awake double lumen intubations were designated for preoperative assessment of pulmonary function in cases planned for pneumonectomy. But later on, the utility of double lumen tubes expanded widely to play a crucial role in adult thoracic surgeries requiring lung isolation. Patients undergoing thoracic surgeries for pulmonary resections are conventionally intubated with double lumen endobronchial tubes to achieve isolation and enable one lung ventilation with the aid of balanced anesthesia. Our objective is to adapt the technique of awake double lumen intubation in selected cases. Although most of the patients for pulmonary resections are intubated under general anesthesia, few selected cases have a need to achieve lung isolation in an awake condition. In such cases an anaesthesiologist gain control on the airway by inserting a double lumen tube with the aid of regional airway blocks.. Methods: A total number of 20 patients were intubated in awake condition with appropriate size double lumen tubes under topical airway anesthesia provided by bilateral superior laryngeal nerve, glossopharyngeal and recurrent laryngeal nerve blocks in selected conditions like large proximal broncho pleural fistula, anterior mediastinal tumors and in patients with difficult airway. Maintenance of spontaneous breathing in conditions like bilateral pulmonary bullae until thoracotomy was performed aided with thoracic epidural analgesia was also possible with this technique. Results: Our experience for a period of 4 years is elaborated and also compared with other institutions, which emphasized renewed interest in awake double lumen intubation under airway anesthesia. Conclusion: The simple and easy technique followed in our hospital might be preferred in selected cases requiring lung isolation as well as maintenance of a patent airway until thoracotomy. This method may also demand a place in difficult airway algorithm in patients requiring lung isolation.

Key-words: Awake double lumen intubation, lung isolation, mediastinal tumors, difficult airway, broncho pleural fistula, bilateral pulmonary bulla.

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