Combination of Parker Flex-IT™ Stylet and McGRATH MAC for effective double lumen tube intubation.

Sir,

Normally double lumen tube (DLT) intubation is often more difficult than single-lumen tube (SLT) intubation, because the outer diameter of a DLT is larger than that of a SLT.[1] Thus, intubation is often performed with a video laryngoscope, such as a McGRATH MAC video laryngoscope (Aircraft Medical, CO, UK). Video laryngoscopy allows indirect visualization and superior view of the glottis; however, advancement of the endotracheal tube through the vocal cords into the trachea may be difficult.[2] A Parker Flex-IT™ Stylet (Parker Medical, CO, USA) can be freely curved by pushing the sum button at the top of the stylet. Although the DLT could not be advanced using the McGRATH MAC video laryngoscope, advancement was possible using a Parker Flex-IT™ Stylet along with the McGRATH MAC video laryngoscope.

A 61-year-old man (height, 165 cm; weight, 85 kg; American Society of Anesthesiologists classification, grade II) with a 15-year history of hypertension underwent right lower lobectomy via video-assisted thoracic surgery. In the operation room, the patient following adequate preoxygenation, anesthesia was induced with 3 μg/ml of propofol and 0.3 μg/kg/min remifentanil. Face mask ventilation was easily performed, and 50 mg of rocuronium was administered. After 3 min, we tried to intubate the 37-Fr left DLT using a McGRATH MAC video laryngoscope. Quick examination of the vocal cords was possible; however, the DLT could not be advanced. Therefore, we tried to intubate the DLT using a Parker Flex-IT™ Stylet along with the McGRATH MAC video laryngoscope [Figure 1]. Easy intubation was possible, and the DLT could be maneuvered at a proper angle using the Parker Flex-IT™ Stylet, while examining the vocal cords. After intubation, no mouth bleeding was observed. In addition, no airway complications were observed during the perioperative period. Therefore, we hypothesize that a combination of a Parker Flex-IT™ Stylet and the McGRATH MAC video laryngoscope can be used as an effective method for DLT intubation.

Figure 1

The 37-Fr left with the Parker Flex-IT™ Stylet. Parker Flex-IT™ Stylet can be freely curved by pushing the sum button (arrow) at the top of the stylet