Comparison of Arndt-endobronchial blocker plus laryngeal mask airway with left-sided double-lumen endobronchial tube in one-lung ventilation in thoracic surgery in the morbidly obese

This study aimed to evaluate the feasibility and performance of Arndt-endobronchial blocker (Arndt) combined with laryngeal mask airway (LMA) compared with left-sided double-lumen endobronchial tube (L-DLT) in morbidly obese patients in one-lung ventilation (OLV). In a prospective, randomized double-blind controlled clinical trial, 80 morbidly obese patients (ASA I-III, aged 20–70) undergoing general anesthesia for elective thoracic surgeries were randomly allocated into groups Arndt (n=40) and L-DLT (n=40). In group Arndt, a LMA™ Proseal was placed followed by an Arndt-endobronchial blocker. In group L-DLT, patients were intubated with a left-sided double-lumen endotracheal tube. Primary endpoints were the airway establishment, ease of insertion, oxygenation, lung collapse and surgical field exposure. Results showed similar ease of airway establishment and tube/device insertion between the two groups. Oxygen arterial pressure (PaO2) of patients in the Arndt group was significantly higher than L-DLT (154±46 vs 105±52 mmHg; P<0.05). Quality of lung collapse and surgical field exposure in the Arndt group was significantly better than L-DLT (effective rate 100 vs 90%; P<0.05). Duration of surgery and anesthesia were significantly shorter in the Arndt group (2.4±1.7 vs 3.1±1.8 and 2.8±1.9 vs 3.8±1.8 h, respectively; P<0.05). Incidence of hoarseness of voice and incidence and severity of throat pain at the post-anesthesia care unit and 12, 24, 48, and 72 h after surgery were significantly lower in the Arndt group (P<0.05). Findings suggested that Arndt-endobronchial blocker combined with LMA can serve as a promising alternative for morbidly obese patients in OLV in thoracic surgery.

本研究旨在评估与左侧双腔支气管导管（left-sided double-lumen endobronchial tube, L-DLT）相比，Arndt支气管内封堵器（Arndt-endobronchial blocker）联合喉罩气道（laryngeal mask airway, LMA）用于病态肥胖患者单肺通气（one-lung ventilation, OLV）的可行性与临床效果。本研究为一项前瞻性、随机双盲对照临床试验，共纳入80例ASA分级I~III级、年龄20~70岁、拟行择期胸外科手术并接受全身麻醉的病态肥胖患者，按1:1随机分为Arndt组（n=40）与L-DLT组（n=40）。Arndt组患者先置入LMA™ Proseal喉罩，随后置入Arndt支气管内封堵器；L-DLT组患者则行左侧双腔支气管导管插管。本研究的主要结局指标包括气道建立情况、插管难易程度、氧合状态、肺萎陷效果及手术视野暴露质量。结果显示，两组患者的气道建立难度与导管/装置置入难易程度无显著差异。Arndt组患者的动脉血氧分压（PaO2）显著高于L-DLT组（154±46 vs 105±52 mmHg；P<0.05）。Arndt组的肺萎陷质量与手术视野暴露质量显著优于L-DLT组（有效率分别为100%与90%；P<0.05）。Arndt组的手术时长与麻醉时长均显著短于L-DLT组（分别为2.4±1.7 vs 3.1±1.8 h、2.8±1.9 vs 3.8±1.8 h；P<0.05）。术后麻醉后监护病房及术后12、24、48、72 h时的声音嘶哑发生率，以及咽喉疼痛的发生率与严重程度，Arndt组均显著低于L-DLT组（P<0.05）。本研究结果表明，Arndt支气管内封堵器联合喉罩气道可作为胸外科手术中病态肥胖患者单肺通气的一种极具应用前景的替代方案。