Double-Lumen Tube Placement Using a Retractable Carinal Hook: A Preliminary Report

Proper placement of a double-lumen tube (DLT) is vital for its optimal functioning. We modified the standard blind method of left-sided DLT placement using a retractable carinal hook. The aim of this study was to determine whether this modified method could improve the success rate of correct initial tube positioning compared with the conventional method. Forty patients scheduled for general anesthesia requiring left-sided DLTs in a prospective, randomized, controlled trial were studied. The incidence of malpositions and time required for proper placement of a DLT using either the conventional method (conventional group, n = 20) or a modified method using a retractable carinal hook (hook group, n = 20) were recorded. The hook is a modified gum elastic bougie. Correct positioning was confirmed by fiberoptic bronchoscopy (FOB). After initial DLTs placement, clinical finding alone detected malpositions in 3 of 20 (15%) and 1 of 20 (5%) patients in the conventional and hook groups, respectively. Subsequent FOB revealed a significantly lower incidence of tube malposition in the hook group 2 of 20 (10%), compared with the conventional group 9 of 20 (45%) (P = 0.03). The time for clinical placement of DLTs was comparable in the two groups (P = 0.63), and the time for FOB confirmation and adjustment was significantly shorter in the hook group (88.9 +/- 35.7 s) compared with the conventional group (152.3 +/- 40.3 s) (P < 0.0001). The use of a retractable carinal hook increased the success rate and shortens the time for correct DLT positioning. Further, larger studies are required to confirm its safety and reliability.