Sequential lobar-lung-lobar isolation using a deflecting tip bronchial blocker

This case report describes the use of a bronchial blocker (BB) with a wheel-controlled tip (Cohen flexitip endobronchial blocker) to provide initially middle and lower right lobe isolation and then right lung isolation (RLI) during right lower lobectomy in a patient with compromised pulmonary function preoperatively. As predicted, RLI and one-lung ventilation were associated with worsening oxygenation. Toward the end of the surgery, RLI was converted back to middle and lower right lobe isolation and oxygenation returned to normal levels. The BB design made lobar isolation easier and enabled repositioning of the BB during surgery. The techniques used for BB insertion as well as lobar and lung separation are described.

Progress in lung separation

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.

Treatment of a transdiaphragmatic fistula with an endobronchial-blocking catheter

We report a case of a bronchosubphrenic fistula in a 59-year-old female following hemicolectomy complicated by fecal peritonitis. The patient needed intubation and positive-pressure ventilation, which caused a massive air leak. The fistula was treated using an endobronchial blocking catheter in combination with antibiotic treatment and drainage.

Lung isolation during port-access cardiac surgery: double-lumen endotracheal tube versus single-lumen endotracheal tube with a bronchial blocker

OBJECTIVE

The purpose of this study was to compare the use of a double-lumen endotracheal tube to a single-lumen tube combined with a bronchial blocker for lung isolation during Port-Access cardiac surgery.

DESIGN

Prospective, randomized, controlled trial.

SETTING

Tertiary care university hospital.

PARTICIPANTS

Thirty-two patients undergoing Port-Access cardiac surgery via a right minithoracotomy.

INTERVENTIONS

Patients were randomized to intubation with either a left-sided double-lumen tube (double-lumen group) or a single-lumen tube with concomitant use of a bronchial blocker (blocker group). Comparisons between groups included (1) intubation time, (2) number of laryngoscopy attempts, (3) time required for tube exchange at the end of the operation, and (4) surgical satisfaction with the lung deflation (1-5 scale: 5 = excellent).

MEASUREMENTS AND MAIN RESULTS

The initial intubation time was similar between groups (118 +/- 82 seconds, double-lumen v 144 +/- 32 seconds, blocker; p = 0.2781). An additional 105 +/- 37 seconds was needed to exchange the double-lumen tube at the end of the operation. The double-lumen group also required more laryngoscopy attempts compared with the blocker group (2.3 +/- 0.6, double-lumen v 1.1 +/- 0.4, blocker; p = 0.0001). The lung deflation was better in the double-lumen group (5 [4-5], double-lumen v 4 [3-5], blocker, p = 0.0414).

CONCLUSIONS

Compared with a single-lumen tube/bronchial blocker combination the double-lumen endotracheal tube required more laryngoscopy attempts and additional time to replace the tube at the end of the case but resulted in slightly better overall lung deflation.