The study by Campos et al.  1presented some interesting findings. It was surprising that the lung isolation device used to achieve one-lung isolation did not provide an advantage to the anesthesiologist with limited experience. There was no difference in frequency of failure or time to successful tube positioning among the three devices. A difference might have been anticipated, especially between the Arndt® blocker and the left-sided double-lumen endotracheal tube (DLT), because the DLT is the most commonly used device for lung isolation,2and bronchial blocking devices generally require longer time for placement compared with the left-sided DLT.3,4The results of the study1are rather concerning, because training and exposure for residents largely consist of the use of the DLT, which is used more often and has been in clinical practice for a longer period of time. Because a combination of unfamiliarity with tracheobronchial anatomy and skill in fiberoptic bronchoscopy was responsible for most of the malpositions,1perhaps training for residents should concentrate on building a stronger foundation in basic knowledge and skill. Personal experience with the routine use of video-bronchoscopy for confirmation of DLT position has shown that it greatly facilitates the learning process. Anatomy can be demonstrated clearly, and due to simultaneous viewing by the attending and resident, there is better appreciation of the steps involved in the identification and correction of any malposition problems. The use of a virtual bronchoscopy simulator may also be useful in skill acquisition in flexible bronchoscopy.5 

Singapore General Hospital, Singapore.

Campos JH, Hallam EA, Van Natta T, Kernstine KH: Device for lung isolation used by anesthesiologists with limited thoracic experience: Comparison of double-lumen endotracheal tube, Univent® torque control blocker, and Arndt wire-guided endobronchial blocker®. Anesthesiology 2006; 104:261–6
Lewis JW, Serwin JP, Gabriel FS, Bastanfar M, Jacobson G: The utility of a double-lumen tube for one-lung ventilation in a variety of noncardiac thoracic procedures. J Cardiothorac Vasc Anesth 1992; 6:705–10
Bauer C, Winter C, Henzt JG, Ducrocq X, Steib A, Dupeyron JP: Bronchial blocker compared to double-lumen tube for one-lung ventilation during thoracoscopy. Acta Anaesthesiol Scand 2001; 45:250–4
Campos JH, Kernstine KH: A comparison of a left-sided Broncho-Cath with the torque control blocker Univent and the wire-guided blocker. Anesth Analg 2003; 96:283–9
Rowe R, Cohen RA: An evaluation of a virtual reality airway simulator. Anesth Analg 2002; 95:62–6