Extubation aid in double lumen tube exchange in difficult airway cases operated for thoracic surgeries.

Sir,

Double lumen tube (DLT) is used in thoracic surgical procedures. A majority of these surgeries mandate postoperative elective ventilation. It is a common practice that DLT is exchanged with conventional endotracheal tube (ETT) before transferring the patient out of the operating room.[1-3] The exchange of the tracheal tube requires a fiberscope, which is not available in many operation theaters in developing countries.

In case the airway is not difficult, the DLT is removed and a conventional ETT is placed in the trachea. However, if the patient has a difficult airway, extubation of DLT should be guarded and a ventilating tube exchanger should be used. Commercially available ETT exchangers are usually 70 cm long and thus may not serve the purpose. Gum elastic bougies and hollow tube exchangers are also not enough long to replace DLT. Some extra-long(Cook's DLT exchanger,100 cm length) tube exchangers are available commercially but they are expensive and their availability is limited.

We have successfully used, in 26 cases, a novel indigenous hollow ventilating DLT tube exchanger i.e., 260 cm length, 0.9 mm Bentson exchange guidewire (Cook®, Medical Inc, Bloomington, IN, USA) sheath. This sheath has appropriate length for above purposes and can be utilized for any sized DLT. It is latex-free, safe, flexible, and easily available. These extra-long sheaths cover the guidewires are used in percutaneous nephrolithotomy surgery by urologists.

DLT of adult sizes (37 F, 39 F) are 45 cm long and to exchange them, a 90 cm tube exchanger is required. In difficult airway situations, hollow ventilating exchangers are always better. On its proximal end of this sheath, 4.0 mm ID ETT connector can be easily mounted [Figure 1], which can be utilized for oxygenation or ventilation during exchange of tubes.

Figure 1

Bentson exchange guidewire sheath with ETT No. 4.00 connector mounted