Airway apparatus for thoracic surgery

One-lung anaesthesia is becoming mandatory for thoracic operations; knowledge of the required apparatus is essential for anaesthetists. Developed in the 1950s from non-anaesthetic apparatus, the double-lumen endobronchial tube (DLT) remains the most widely used piece of equipment in this field. The early rubber tubes are giving way to modern plastic, but the principle and function of the DLT remains unchanged. The introduction of robust fine fibreoptic bronchoscopes (FOB) has improved the positioning of tubes, and also stimulated the reintroduction of bronchus blockers. Miniature video cameras have recently been incorporated into tracheal tubes, giving a constant view of the lower airway during anaesthesia. This article outlines the development and use of the currently available double-lumen tubes and bronchus blockers. It concludes with comparison of the two methods of lung isolation.