Lung Isolation Devices: Success Depends on Proper Equipment

Lung isolation is an important aspect of thoracic anaesthesia and certain emergency procedures. The equipment available for this are double-lumen tube (DLT), Univent tube, and Endobronchial blockers. The development in thoracic surgery has been made possible due to the development in the equipment for lung isolation. In 1931, about 3 years after the introduction of cuffed endotracheal tube by Guedel and Waters, a technique for selective one-lung ventilation with a cuffed tube was described by Gale and Waters. Archibald, in 1935 described the first bronchial blocker for the control of secretions during one-lung ventilation, which was followed by Magill’s bronchial blocker with improved design in the following year. In 1949, Carlens described a double-cuffed, double-lumen tube that was intended for differential bronchospirometry, but was used successfully for selective one-lung anaesthesia. Design modifications soon followed and Robertshaw double-lumen tube was introduced in 1962. Disposable plastic double-lumen tubes are in use since 1980s and have generally replaced the older rubber tubes.