• Jesse M Ehrenfeld, William Mulvoy, and Warren S Sandberg.
• Department of Anesthesia and Critical Care, Massachusetts General Hospital, Boston, MA 02114, USA. jehrenfeld@partners.org
• J. Cardiothorac. Vasc. Anesth. 2010 Aug 1; 24 (4): 598-601.

ObjectiveTo compare performance of right- versus left-sided double-lumen tubes (DLTs) among infrequent users by evaluating the incidence and severity of hypoxemia, hypercapnia, and high airway pressures.DesignA retrospective, cohort study.SettingA university hospital.ParticipantsNinety-eight patients undergoing left-sided DLT placement (53.9 +/- 21.2 years old) and 98 patients undergoing right-sided DLT placement (62.3 +/- 20.6 years old). Cases performed by thoracic anesthesia specialists were excluded.InterventionsThe authors retrospectively reviewed electronic anesthetic records from a 2-year period to determine the incidence and severity of hypoxia (SpO(2) < 90%), hypercapnia (end-tidal carbon dioxide > 45 mmHg) and high airway pressures (peak inspiratory pressure >35 cmH(2)O) during one-lung ventilation via right and left DLTs.Measurements And Main ResultsRight-sided (n = 98) DLTs were almost exclusively used on the side contralateral to surgery by infrequent users, whereas left-sided (n = 98) DLTs were used for ipsilateral surgery one third of the time. Hypoxia lasted longer in left versus right DLTs, but the frequency of hypoxia was the same for each tube type among infrequent users. Hypercapnia and high airway pressures occurred more frequently with left-sided DLTs.ConclusionsLeft-sided DLTs are perceived to be safer because they may be less prone to malpositioning during lung isolation. However, the supposition that left-sided DLTs are safer than right-sided DLTs when intraoperative hypoxia, hypercapnia, and high airway pressures are used as criteria, even when these tubes are used by infrequent users, is not supported by the data.Copyright 2010 Elsevier Inc. All rights reserved.

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