4. Discussion
DLD, hypoxia, airway damage
HYPOXIA, POSTOPERATIVE COMPLICATION, COMPLICATIONS
Double lumen intubation was a standard choice for ETSB surgery during the early years.In our patients with SLT and lung deflation problems, we employed HFPPV and provided an adequate working area for the surgeon in short-term video assisted thoracic surgeries operations. With this technique, we did not observe a difference in oxygenation between the patients in whom we applied SLT and those in whom DLT was applied.Similar to previous reports, we found that the choice of intubation affects neither surgical comfort nor the postoperative complication rate. DLD is the most challenging obstacle and therefore was the primary focus of this trial. Our results indicate that the choice of intubation does not affect the incidence of DLD. This finding indicates that DLD is probably due to the patient’s unrecognized constitutional factor(s). Further research on this matter is required to shed light on the underlying mechanism of intraoperative lung resistance.Several studies compared postoperative anesthesiologic complications of DLT versus SLT. For example, it is well known that the incidence of airway damage is higher in DLT patients.DLT is considered as more time and effort consuming than SLT. To test this hypothesis, we recorded total anesthesia time and found minimal difference favoring SLT. Although the difference wasn’t statistically significant (This study has several limitations. First, it was performed at a single institution. Therefore, the multi-center study is required to rule out institution-related bias. Second, for obvious reasons neither anesthesiologist nor the surgeon were blinded to treatment groups which adds bias to our study. And also, the number of patients in our study is another serious limitation. Another limitation to our study was we did not no compare between intraoperative oxygen saturation and blood gas carbon dioxide partial pressure. Because high-frequency ventilation may affect ventilation function, leading to hypoxia and carbon dioxide accumulation.In conclusion, We reported that DLT and single lumen tracheal intubation were equally effective for lung deflation during surgery, and SLT with HFPPV ventilation mode during ETSB surgery provided the surgeon with an adequate and clean workspace with shorter onset of anesthesia. We may suggest the HFPPV technique for uncomplicated surgery groups or where sufficient conditions for DLT cannot be provided in the operating room.