Endotracheal kinking of a double-lumen tube: a potential complication of inappropriate size tube selection.

Editor, An objective method for selecting an appropriate size double-lumen tube (DLT) has been a matter of discussion for many years. Some anaesthesiologists choose a DLT based on the sex and height of the patient, whereas tube selection based on the radiographic measurement of the airway has been proposed. We recently had a complication that, we believe was because of selection of a DLT that was too large for our patient who was a 34-year-old, ASA II, male (weight 75 kg and height 190 cm) scheduled for video-assisted thoracoscopy for repair of a spontaneous pneumothorax. Following induction of general anaesthesia and muscle relaxation, direct laryngoscopy with a Macintosh laryngoscope blade demonstrated a Cormack–Lehane grade II view. We experienced difficulty trying to pass a left 41-Fr nonbevelled DLT (Rüsch Bronchoport; Teleflex Medical, Athlone, Ireland) through the glottis. We then repeated the manoeuvre with an Airtraq laryngoscope specifically designed for DLTs (Prodol; Fannin Limited, Reading, UK). In order to lodge the DLT in the curved conduit of the Airtraq scope, the stylet was removed from the bronchial lumen. Complete visualization of the glottic space was achieved. We experienced mild resistance at the glottic opening and again when we stopped advancement of the tube at a depth of 31 cm from the incisor teeth.