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 flexible bronchoscopes (FB) has improved the positioning of tubes, and also stimulated the reintroduction of bronchus blockers. Miniature video cameras have recently been incorporated into both tracheal tubes and flexible bronchoscopes, improving visualization of the lower airway during anaesthesia. This article outlines the development and use of the currently available DLTs and bronchus-blockers. It concludes with comparison of the two methods of lung isolation.