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K Depal VN, Ansari FA, Maitra S. Use of Arndt bronchial blocker through nasal RAE endotracheal tube in a patient with limited mouth opening. J Anaesthesiol Clin Pharmacol 2020; 36:123-125. [PMID: 32174676 PMCID: PMC7047705 DOI: 10.4103/joacp.joacp_346_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Revised: 04/09/2019] [Accepted: 04/09/2019] [Indexed: 11/04/2022] Open
Affiliation(s)
- Vini N K Depal
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Furkan Akhtar Ansari
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Souvik Maitra
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
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Collins SR, Titus BJ, Campos JH, Blank RS. Lung Isolation in the Patient With a Difficult Airway. Anesth Analg 2019; 126:1968-1978. [PMID: 29189274 DOI: 10.1213/ane.0000000000002637] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
One-lung ventilation is routinely used to facilitate exposure for thoracic surgical procedures and can be achieved via several lung isolation techniques. The optimal method for lung isolation depends on a number of factors that include (1) the indication for lung isolation, (2) anatomic features of the upper and lower airway, (3) availability of equipment and devices, and (4) the anesthesiologist's proficiency and preferences. Though double-lumen endobronchial tubes (DLTs) are most commonly utilized to achieve lung isolation, the use of endobronchial blockers offer advantages in patients with challenging airway anatomy. Anesthesiologists should be familiar with existing alternatives to the DLT for lung isolation and alternative techniques for DLT placement in the patient with a difficult airway. Newer technologies such as videolaryngoscopy with or without adjunctive fiberoptic bronchoscopy may facilitate intubation and lung isolation in difficult airway management.
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Affiliation(s)
- Stephen R Collins
- From the Department of Anesthesiology, University of Virginia Health System, Charlottesville, Virginia
| | - Brian J Titus
- From the Department of Anesthesiology, University of Virginia Health System, Charlottesville, Virginia
| | - Javier H Campos
- Department of Anesthesia, University of Iowa Healthcare, Iowa City, Iowa
| | - Randal S Blank
- From the Department of Anesthesiology, University of Virginia Health System, Charlottesville, Virginia
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Campos JH, Musselman ED, Hanada S, Ueda K. Lung Isolation Techniques in Patients With Early-Stage or Long-Term Tracheostomy: A Case Series Report of 70 Cases and Recommendations. J Cardiothorac Vasc Anesth 2018; 33:433-439. [PMID: 30190202 DOI: 10.1053/j.jvca.2018.05.033] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Lung isolation techniques are designed to facilitate surgical exposure in thoracic surgical patients and provide one-lung ventilation (OLV). Some patients have a tracheostomy in situ, which makes the management of the airway and OLV difficult. The objective of this retrospective study was to review cases that had a tracheostomy prior to thoracic surgery and evaluate the clinical use and efficiency with the airway management and lung isolation devices. DESIGN This was a retrospective data analysis. SETTING Tertiary care university hospital. INTERVENTIONS After institutional review board approval, the authors reviewed 3,225 charts of patients who had thoracic surgery involving OLV. Seventy patients were identified who had tracheostomy in situ. Each case was reviewed regarding airway management and lung isolation technique. MEASUREMENTS AND MAIN RESULTS The authors identified 70 patients who had a tracheostomy in situ. The cases were divided into 2 groups: a fresh tracheostomy stoma <7 days (n = 6) or long-term stoma >7 days (n = 64). The authors collected information regarding the devices used to manage the airway and lung isolation techniques. The devices used to manage the airway include the Shiley cuffed low pressure tracheostomy tube, single-lumen endotracheal tube (SLT), or double-lumen endotracheal tube (DLT). Devices used to manage OLV included SLTs, with or without bronchial blockers, or DLTs. Flexible fiberoptic bronchoscopy was used to assess the airway and confirm the position of the lung isolation device. Six cases had an early-stage fresh tracheostomy stoma where the Shiley tracheostomy tube was used for ventilation followed by the use of a bronchial blocker. In contrast, for the patients who had a long-term stoma, the following devices were used: (1) a SLT plus a bronchial blocker in 38 cases, a Shiley tracheostomy tube plus bronchial blocker in 15 cases, use of a SLT guided into a selective bronchus in 7 cases, and use of a DLT in 4 cases. In all cases, flexible fiberoptic bronchoscopy was used and no complications occurred secondary to airway management or OLV. CONCLUSION In patients undergoing thoracic surgery and OLV, and with a fresh tracheostomy stoma in situ, the authors recommend the use of the Shiley tracheostomy tube plus a bronchial blocker. In patients with a long-term tracheostomy stoma, a SLT can be used selectively to intubate 1 bronchus. In addition, an SLT or a Shiley tube can be used in conjunction with an independent bronchial blocker, such as the Arndt wire-guided bronchial blocker, Cohen tip-deflecting blocker, Fuji Uniblocker, or EZ-Blocker. DLTs are the least frequently used device for OLV in tracheostomized patients.
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Affiliation(s)
- Javier H Campos
- Department of Anesthesia, University of Iowa Health Care, Iowa City, IA.
| | - Eli D Musselman
- Department of Anesthesia, University of Iowa Health Care, Iowa City, IA
| | - Satoshi Hanada
- Department of Anesthesia, University of Iowa Health Care, Iowa City, IA
| | - Kenichi Ueda
- Department of Anesthesia, University of Iowa Health Care, Iowa City, IA
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Campos JH. Guidelines, algorithms, and recommendations during the management of the difficult airways in the thoracic surgical patient: Are they supported by evidence based? ACTA ACUST UNITED AC 2017; 65:1-4. [PMID: 29183633 DOI: 10.1016/j.redar.2017.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 10/30/2017] [Accepted: 11/02/2017] [Indexed: 11/19/2022]
Affiliation(s)
- J H Campos
- Department of Anesthesia, University of Iowa Health Care, Iowa City, Iowa, Estados Unidos.
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Abstract
One-lung ventilation is used during a variety of cardiac, thoracic, and major vascular procedures. Endobronchial tubes, bronchial blockers, and occasionally, single-lumen tubes are used to isolate the lungs. Patients with difficult airways and pediatric patients provide special challenges for lung isolation. Finally, intraoperative hypoxia and hypercarbia in patients with intrinsic lung disease frequently complicate one-lung anesthesia. The concepts and controversies in lung isolation techniques are discussed.
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Affiliation(s)
- Edwin Mirzabeigi
- Martin Luther King, Jr/Charles R. Drew University Medical Center, Department of Anesthesiology, Los Angeles, CA 90069, USA
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Wang S, Zhang J, Cheng H, Yin J, Liu X. A Clinical Evaluation of the ProSeal Laryngeal Mask Airway With a Coopdech Bronchial Blocker for One-Lung Ventilation in Adults. J Cardiothorac Vasc Anesth 2014; 28:900-3. [DOI: 10.1053/j.jvca.2013.06.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Indexed: 11/11/2022]
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Lim H, Weinberg L, Tan CO, Tay S, Kolivas C, Peyton P. Airway strategies for lung isolation in a patient with high-velocity nail gun injuries to the right cardiac ventricle and floor of the mouth: a case report. J Med Case Rep 2013; 7:137. [PMID: 23714118 PMCID: PMC3680235 DOI: 10.1186/1752-1947-7-137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Accepted: 04/03/2013] [Indexed: 11/10/2022] Open
Abstract
Introduction We report a case of deliberate self-harm in which three three-inch nails were fired from a nail gun resulting in mandibular fixation and two penetrating injuries to the right cardiac ventricle. This combination of high-velocity penetrating injury has not been previously described. Case presentation A 69-year-old Caucasian man with a medical history of chronic depression was brought to hospital after a failed suicide attempt. The attempt consisted of self-asphyxiation with car exhaust fumes and shooting himself thrice with a three-inch nail gun. He sustained a penetrating nail injury to the floor of his mouth, effectively pinning his mouth closed, and penetrating injuries to the right ventricular free wall and at the junction of the right atrioventricular septum. The patient required emergency surgery with requirements for thoracotomy and sternotomy, lung isolation and cardiopulmonary bypass. Conclusions This is the first reported case of a combination high-velocity penetrating nail gun injury to the face and the right cardiac ventricle. This rare case offers airway strategies to accommodate the surgical requirement for lung separation for penetrating chest trauma in a patient with iatrogenically limited mouth opening.
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Affiliation(s)
- Herman Lim
- Department of Anaesthesia, Austin Hospital, 145 Studley Road, Heidelberg, VIC, 3084, Australia.
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Seong YW, Kang CH, Kim JT, Moon HJ, Park IK, Kim YT. Video-Assisted Thoracoscopic Lobectomy in Children: Safety, Efficacy, and Risk Factors for Conversion to Thoracotomy. Ann Thorac Surg 2013; 95:1236-42. [DOI: 10.1016/j.athoracsur.2013.01.013] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2012] [Revised: 01/10/2013] [Accepted: 01/11/2013] [Indexed: 11/28/2022]
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Murakawa T, Ito N, Fukami T, Nakajima J, Takamoto S. Application of lobe-selective bronchial blockade against airway bleeding. Asian Cardiovasc Thorac Ann 2010; 18:483-5. [PMID: 20947606 DOI: 10.1177/0218492310380279] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A 48-year-old man underwent resection of a right upper lobe necrotic tumor and part of his chest wall. Lobe-selective bronchial blockade of bleeding from the right upper lobe was achieved by combining a left-side double-lumen endotracheal tube with a bronchial blocker placed at the right intermediate bronchus. The bleeding right upper lobe was isolated, and the other lobes were protected from blood contamination during the lobectomy procedure.
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Affiliation(s)
- Tomohiro Murakawa
- Department of Cardiothoracic Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
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Accidental fracture of the tip of the Coopdech bronchial blocker during insertion for one lung ventilation. Can J Anaesth 2010; 57:350-4. [DOI: 10.1007/s12630-009-9261-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2009] [Accepted: 12/18/2009] [Indexed: 11/28/2022] Open
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Neustein SM. The Use of Bronchial Blockers for Providing One-Lung Ventilation. J Cardiothorac Vasc Anesth 2009; 23:860-8. [PMID: 19632864 DOI: 10.1053/j.jvca.2009.05.014] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2009] [Indexed: 11/11/2022]
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Robinson AR, Gravenstein N, Alomar-Melero E, Peng YG. Lung Isolation Using a Laryngeal Mask Airway and a Bronchial Blocker in a Patient With a Recent Tracheostomy. J Cardiothorac Vasc Anesth 2008; 22:883-6. [DOI: 10.1053/j.jvca.2007.09.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2007] [Indexed: 11/11/2022]
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Cohen E. Pro: The New Bronchial Blockers Are Preferable to Double-Lumen Tubes for Lung Isolation. J Cardiothorac Vasc Anesth 2008; 22:920-4. [PMID: 19038740 DOI: 10.1053/j.jvca.2008.09.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2008] [Indexed: 02/08/2023]
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Espí C, García-Guasch R, Ibáñez C, Fernández E, Astudillo J. [Selective lobar blockade using an arndt endobronchial blocker in 2 patients with respiratory compromise who underwent lung resection]. Arch Bronconeumol 2007; 43:346-8. [PMID: 17583645 DOI: 10.1016/s1579-2129(07)60081-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Selective lobar blockade is an alternative to one-lung ventilation in thoracic surgery. We present 2 cases of lung resection with severe respiratory compromise. The first patient had previously undergone a left lower lobectomy and 2 atypical resections in the left and right upper lobes and was scheduled for a right lower lobectomy. The second patient presented chronic obstructive pulmonary disease with forced vital capacity of 1200 mL (26% of predicted value) and forced expiratory volume in 1 second of 820 mL (25% of predicted value) and was scheduled for an atypical resection of the left upper lobe with pleural abrasion. Selective lobar blockade was achieved in both cases using an Arndt endobronchial blocker. Ventilation during the operation was sufficient. Surgery was uneventful in both cases and lobar collapse was satisfactory.
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Affiliation(s)
- Clara Espí
- Hospital Universitario Germans Trias i Pujol, Carretera Canyet s/n, 08916 Badalona, Barcelona, Spain.
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Espí C, García-Guasch R, Ibáñez C, Fernández E, Astudillo J. Bloqueo lobular selectivo mediante el bloqueador bronquial de Arndt en 2 pacientes con compromiso respiratorio sometidos a resección pulmonar. Arch Bronconeumol 2007. [DOI: 10.1157/13106566] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Campos JH. Which device should be considered the best for lung isolation: double-lumen endotracheal tube versus bronchial blockers. Curr Opin Anaesthesiol 2007; 20:27-31. [PMID: 17211163 DOI: 10.1097/aco.0b013e3280111e2a] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW This review is a clinical comparison between double-lumen endotracheal tubes and bronchial blockers to determine which device is considered the best for lung isolation. RECENT FINDINGS Double-lumen endotracheal tubes and bronchial blockers have been found to be clinically equivalent in terms of performance in providing lung collapse for patients with normal airways. In the last five years, however, numerous reports have indicated a preference for the use of bronchial blockers in patients with airway abnormalities. For nonthoracic anesthesiologists who have limited experience in thoracic anesthesia cases, none of the devices (double-lumen tubes or bronchial blockers) have been shown to provide any advantage while in use due to a high incidence of unrecognized malpositions. Overall, each device provides advantages depending upon the case, such as absolute lung separation with a double-lumen endotracheal tube or the use of a bronchial blocker in a difficult airway for a patient requiring lung isolation. SUMMARY Double-lumen endotracheal tubes and bronchial blockers should be part of the armamentarium of every anesthesiologist involved in lung isolation techniques and every device should be tailored to specific case needs.
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Affiliation(s)
- Javier H Campos
- University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, Iowa 52242, USA.
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Lohser J, Donington JS, Mitchell JD, Brodsky JB, Raman J, Slinger P. Case 5--2005: anesthetic management of major hemorrhage during mediastinoscopy. [clin conf]. J Cardiothorac Vasc Anesth 2005; 19:678-83. [PMID: 16202909 DOI: 10.1053/j.jvca.2005.07.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2005] [Indexed: 11/11/2022]
Affiliation(s)
- Jens Lohser
- Department of Anesthesia, Stanford University School of Medicine, Stanford, CA 94305-5640, USA.
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Abstract
The progress in lung separation technology has allowed anesthesiologists to become skillful in fiberoptic bronchoscopy techniques and to provide excellent lung exposure in thoracic surgery patients. Given the availability of two technologies--DLTs (right-sided and left-sided) and bronchial blocker technology (TCBU, Arndt, and Cohen--every case that requires lung collapse and OLV should receive the benefit of these devices. Because of its greater margin of safety, a left-sided DLT is the more common device used in lung separation. If any contraindication to placing a left-sided DLT exists, a right-sided DLT is an option for any specific situation (eg, left lung transplantation). For a patient who requires lung separation and presents with the dilemma of a difficult or abnormal airway, bronchial blockers offer more advantages. Regardless of the device used, the optimal position of these devices (DLTs and bronchial blockers) is achieved best with the use of fiberoptic bronchoscopy techniques first in supine and then in lateral decubitus position or whenever repositioning of the device is needed.
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Affiliation(s)
- Javier H Campos
- Department of Anesthesia, University of Iowa Health Care, 200 Hawkins Drive, Iowa City, IA 52242-1079, USA.
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Abstract
Techniques for one-lung ventilation (OLV) can be accomplished in two ways: The first involves the use of a double-lumen endotracheal tube (DLT). The second involves blockade of a mainstem bronchus (bronchial blockers). Bronchial blockade technology is on the rise, and in some specific clinical situations (e.g., management of the difficult airway during OLV or selective lobar blockade) it can offer more as an alternative to achieve OLV in adults. Special emphasis on newer information for the use of Fogarty embolectomy catheter as a bronchial blocker, the torque control blocker Univent, and the wire-guided endobronchial blocker (Arndt blocker) is included. Also this review describes placement, positioning, complications, ventilation modalities, and airflow resistances of all three bronchial blockers. Finally, the bronchial blockers can be used in many cases that require OLV, taking into consideration that bronchial blockers require longer time for placement, assisted suction to expedite lung collapse, and the use of fiberoptic bronchoscopy. The current use of bronchial blockers, supported by scientific evidence, dictates that bronchial blockers should be available in any service that performs lung separation techniques.
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Affiliation(s)
- Javier H Campos
- Department of Anesthesia, University of Iowa Health Care, Iowa City, Iowa
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