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One lung ventilation techniques in infants and small children. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2022.102314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Dillemans J, Van Gompel C, Wouters P, Vanpeteghem C. Technical failure of the EZ‐blocker™ causing serious adverse events during one lung ventilation: a case series. Anaesth Rep 2022; 10:e12160. [PMID: 35434636 PMCID: PMC9006229 DOI: 10.1002/anr3.12160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/01/2022] [Indexed: 11/07/2022] Open
Abstract
We present a case series of intra-operative adverse events while using a specific type of bronchial blocker, designed to facilitate device positioning and minimise the risk of dislocation. The Rüsch® EZ-blocker™ (Teleflex Life Sciences Ltd., Athlone, Ireland) is a Y-shaped catheter equipped with two separately inflatable cuffs at the tip - one for each bronchial lumen. In this report, we describe four cases where the use of the EZ-blocker was associated with the development of high airway pressures, hypoxaemia and expansion of the non-dependent lung. Bronchoscopic evaluation showed spontaneous inflation of the cuff within the dependent (i.e. ventilated) bronchus, causing bronchial obstruction, and volume loss of the cuff within the non-dependent (i.e. unventilated) bronchus, causing unintended expansion of the non-dependent lung. After removal of the bronchial blocker, the catheter showed no visible defect, but a bench test revealed a functional connection inside the catheter which allowed air to pass slowly from one bronchial cuff to the other. This technical defect relates to the unique design of the EZ-blocker as it is the only bronchial blocker equipped with two bronchial cuffs. Clinicians should be aware of this inherent risk since complications may develop insidiously and affect both lungs simultaneously. Early recognition and prompt intervention can prevent life-threatening intra-operative deterioration.
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Affiliation(s)
- J. Dillemans
- Department of Anaesthesiology and Perioperative Medicine Ghent University Hospital Belgium
| | - C. Van Gompel
- Department of Anaesthesiology and Perioperative Medicine Ghent University Hospital Belgium
| | - P. Wouters
- Department of Anaesthesiology and Perioperative Medicine Ghent University Hospital Belgium
| | - C. Vanpeteghem
- Department of Anaesthesiology and Perioperative Medicine Ghent University Hospital Belgium
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Risse J, Szeder K, Schubert AK, Wiesmann T, Dinges HC, Feldmann C, Wulf H, Meggiolaro KM. Comparison of left double lumen tube and y-shaped and double-ended bronchial blocker for one lung ventilation in thoracic surgery—a randomised controlled clinical trial. BMC Anesthesiol 2022; 22:92. [PMID: 35366801 PMCID: PMC8976407 DOI: 10.1186/s12871-022-01637-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 03/25/2022] [Indexed: 11/10/2022] Open
Abstract
Background Double lumen tube (DLT) intubation is the most commonly used technique for one lung ventilation. Bronchial blockers (BB) are an alternative, especially for difficult airways. The EZ-bronchial blocker (EZB) is an innovative y-shaped and double-ended device of the BB family. Methods A randomised, controlled trial was conducted in 80 patients undergoing elective thoracic surgery using DLT or EZB for one lung ventilation (German Clinical Trial Register DRKS00014816). The objective of the study was to compare the clinical performance of EZB with DLT. Primary endpoint was total time to obtain successful one lung ventilation. Secondary endpoints were time subsections, quality of lung collapse, difficulty of intubation, any complications during the procedure, incidence of objective trauma of the oropharynx and supraglottic space and intubation-related subjective symptoms. Results 74 patients were included, DLT group (n = 38), EZB group (n = 36). Median total time to obtain one lung ventilation [IQR] in the DLT group was 234 s [207 to 294] versus 298 s [243 to 369] in the EZB group (P = 0.007). Median total time was relevantly influenced by different preparation times. Quality of lung collapse was equal in both groups, DLT group 89.5% were excellent vs. 83.3% in the EZB group (P = 0.444). Inadequate lung collapse in five patients of the EZB group resulted in unsuccessful repositioning attempts and secondary DLT placement. Endoscopic examinations revealed significantly more carina trauma (P = 0.047) and subglottic haemorrhage (P = 0.047) in the DLT group. Postoperative subjective symptoms (sore throat, hoarseness) were more common in the DLT group, as were speech problems. Conclusions Using EZB prima facie results in prolonged time to obtain one lung ventilation with equal quality of lung collapse for the thoracic surgeon. If preparation times are omitted in the analysis, the time difference is statistically and clinically not relevant. Our data showed only little evidence for reducing objective airway trauma as well as subjective complaints. In summary both procedures were comparable in terms of times and clinical applicability. Therefore decisions for DLT or EZB should depend more on individual experience, in-house equipment and the individual patient, than on any times that are neither clinically significant nor relevant. Trial registration German Clinical Trial Register DRKS00014816, prospectively registered on 07.06.2018
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Mohammad Shehata I, Elhassan A, Zaman B, Viswanath O. Challenge of Lung Isolation in Patients with Vocal Cord Implants. Anesth Pain Med 2022; 12:e123370. [PMID: 35433377 PMCID: PMC8995872 DOI: 10.5812/aapm.123370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 02/20/2022] [Indexed: 12/05/2022] Open
Abstract
Glottic closure insufficiency increases the risk of aspiration and pneumonia, particularly in the elderly. Medialization thyroplasty is an open surgical procedure for treating glottic incompetency by approximating both vocal folds. The vocal fold medialization is achieved by inserting an implant to bring the nonmobile fold to the unaffected side. Lung isolation in patients with vocal cord implantation poses a unique challenge. Understanding the risks of different modalities of lung isolation and their impacts on the vocal cord implant is crucial to implementing a specifically tailored plan. Preoperative bronchoscopy, intraoperative video laryngoscopy, and bronchoscopy are ideal methods for assessing the vocal fold implants and guiding the lung isolation technique. Bronchial blocker through a single-lumen endotracheal tube may be the preferred choice to avoid the injury of the stretched vocal cords and dislodgement of the implant by a larger diameter double-lumen tube.
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Affiliation(s)
- Islam Mohammad Shehata
- Department of Anesthesiology, Ain Sham University, Cairo, Egypt
- Corresponding Author: Department of Anesthesiology, Ain Sham University, Cairo, Egypt.
| | - Amir Elhassan
- Community Memorial Hospital Center, Ventura, California, USA
| | - Behrooz Zaman
- Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
- Corresponding Author: Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran.
| | - Omar Viswanath
- Department of Anesthesiology, Louisiana State University Health Shreveport, Shreveport, Los Angeles, USA
- Valley Anesthesiology and Pain Consultants, Envision Physician Services, Phoenix, Arizona, USA
- Department of Anesthesiology, University of Arizona College of Medicine, Phoenix, Arizona, USA
- Department of Anesthesiology, Creighton University School of Medicine, Omaha, Nebraska, USA
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Comparison of EZ blocker and left double-lumen endotracheal tube for one lung ventilation in minimally invasive cardiac surgery. JOURNAL OF SURGERY AND MEDICINE 2021. [DOI: 10.28982/josam.932472] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
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Choudhry DK, Brenn BR, DiSilvio GM. Endobronchial Blocker Placement for Lung Isolation in Children: A Simple Head Turn Technique. A A Pract 2021; 15:e01390. [PMID: 33577172 DOI: 10.1213/xaa.0000000000001390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Endobronchial blockers are frequently used for lung isolation in children <8 years of age. The aim of our report is to highlight the problem that we have encountered with the wire-guided endobronchial blocker (WEB), where the wire loop used to couple the blocker and the fiberoptic scope (FOS) may straddle the carina. We describe the "uncoupled head turn technique" that we have adopted to avoid this problem. If the coupled technique is deemed necessary, a method to keep the wire loop snug around the FOS is described to avoid the straddling problem.
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Affiliation(s)
- Dinesh K Choudhry
- From the Department of Anesthesiology, Shriners Hospital for Children, Philadelphia, Pennsylvania
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Maddali MM, Zacharias S, Kandachar PS, Annamalai A, Abolwafa A, Ananthasubramanian R, Nguyen K, Diaz-Castrillon CE, Viegas M. Bronchial Disruption Repair in a Child: Suggestions for Opting for One-Lung Ventilation or Extracorporeal Circulatory Support. J Cardiothorac Vasc Anesth 2020; 34:3146-3153. [PMID: 32684429 DOI: 10.1053/j.jvca.2020.06.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 06/13/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Madan Mohan Maddali
- Department of Cardiac Anesthesia, National Heart Center, Royal Hospital, Muscat, Sultanate of Oman.
| | - Sunny Zacharias
- Department of Cardiothoracic Surgery, National Heart Center, Royal Hospital, Muscat, Sultanate of Oman
| | | | - Anbarasu Annamalai
- Department of Cardiac Anesthesia, National Heart Center, Royal Hospital, Muscat, Sultanate of Oman
| | - Amr Abolwafa
- Department of Cardiothoracic Surgery, National Heart Center, Royal Hospital, Muscat, Sultanate of Oman
| | | | - Khoa Nguyen
- Department of Anesthesiology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
| | | | - Melita Viegas
- Department of Pediatric Cardiac Surgery, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
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Gilbert CR, Mallow C, Wishire CL, Chang SC, Yarmus LB, Vallieres E, Haeck K, Gorden JA. A Prospective, Ex Vivo Trial of Endobronchial Blockade Management Utilizing 3 Commonly Available Bronchial Blockers. Anesth Analg 2019; 129:1692-1698. [PMID: 31743190 DOI: 10.1213/ane.0000000000004397] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Lung isolation with bronchial blockers is a well-described and accepted procedure, often described for use during the management of massive hemoptysis. Recommendations for balloon inflation are sparse, with some advocating for saline whereas other suggest air, including the manufacturers. We sought to evaluate the optimal method for balloon inflation in an ex vivo trial. METHODS We performed a prospective trial utilizing 3 commercially available bronchial blockers commonly described for use in lung isolation and massive hemoptysis management. We utilized the Arndt Endobronchial Blocker (Cook Medical), the Cohen Tip Deflecting Endobronchial Blocker (Cook Medical), and the Fogarty Venous Thrombectomy Catheter (Edwards LifeSciences). Balloon size and deflation assessment were tested within 3 different scenarios comparing air versus saline.Welch t test was performed to compare means between groups, and a generalized estimating equation model was utilized to compare balloon diameter over time to account for correlation among repeated measures from the same balloon. RESULTS All 3 endobronchial blocker systems were observed in triplicate. During free-standing balloon inflation, all 3 endobronchial systems displayed a greater degree of balloon deflation over time with air as opposed to saline (P < .001). Within a stent-based model, inflation with air of all 3 endobronchial systems, according to manufacturer recommendations, demonstrated significantly decreased time until fluid transgression occurred when compared to a saline model (P < .001). Within a stent-based model, inflation with air, according to clinical judgment, demonstrated significantly decreased time until fluid transgression in the Arndt (P = .016) and the Fogarty (P < .001) system, but not the Cohen (P = .173) system, when compared with saline. CONCLUSIONS The utilization of saline for balloon inflation during bronchial blockade allows for more consistent balloon inflation. The use of saline during balloon inflation appears to delay passive, spontaneous balloon deflation time when compared to air during a model of endobronchial blockade. The approach of saline inflation should be tested in humans to demonstrate the overall applicability and validity of the current findings.
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Affiliation(s)
- Christopher R Gilbert
- From the Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, Washington
| | - Christopher Mallow
- Interventional Pulmonology, Division of Pulmonary and Critical Care Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Candice L Wishire
- From the Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, Washington
| | - Shu-Ching Chang
- Medical Data Research Center, Providence St Joseph Health, Portland, Oregon
| | - Lonny B Yarmus
- Interventional Pulmonology, Division of Pulmonary and Critical Care Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Eric Vallieres
- From the Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, Washington
| | - Katherine Haeck
- US Anesthesia Partners - Washington, Swedish Medical Center, Seattle, Washington
| | - Jed A Gorden
- From the Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, Washington
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Moritz A, Schmidt J, Schreiner W, Birkholz T, Sirbu H, Irouschek A. Combined recurrent laryngeal nerve monitoring and one-lung ventilation using the EZ-Blocker and an electromyographic endotracheal tube. J Cardiothorac Surg 2019; 14:111. [PMID: 31217035 PMCID: PMC6585134 DOI: 10.1186/s13019-019-0927-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 06/03/2019] [Indexed: 01/01/2023] Open
Abstract
Background Intraoperative neuromuscular monitoring (IONM) is a widespread procedure to identify and protect the recurrent laryngeal nerve (RLN) during thyroid surgery. However, for left thoracic surgery with high risk of RLN injury, both reliable recurrent laryngeal nerve monitoring and one-lung ventilation could interfere. Methods In this prospective study, a new method for IONM during one-lung ventilation combining RLN monitoring with an electromyographic (EMG) endotracheal tube (ETT) and lung separation using the EZ-Blocker (EZB) is described and its clinical feasibility and effectiveness were assessed. Results A total of 14 patients undergoing left upper lobe surgery and left upper mediastinal lymph node dissection were enrolled. The EZB was introduced and positioned without any problems and sufficient lung collapse was achieved in all patients. No tracheobronchial injuries or immediate complications occurred. A stable EMG signal was present in all patients and no RLN palsy and no negative side effects of the NIM EMG ETT or the EZB were observed postoperatively. Conclusions The described method is technically feasible, easy to apply and save. It provides both reliable IONM and independent lung separation for optimal surgical exposure. The combined use of the EZB and the NIM EMG ETT might reduce the risk for RLN palsy and impaired lung separation during left thoracic surgery with high risk for RLN injury.
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Affiliation(s)
- Andreas Moritz
- Department of Anesthesiology, University Hospital of Erlangen, Krankenhausstrasse 12, 91054, Erlangen, Germany.
| | - Joachim Schmidt
- Department of Anesthesiology, University Hospital of Erlangen, Krankenhausstrasse 12, 91054, Erlangen, Germany
| | - Waldemar Schreiner
- Department of Thoracic Surgery, University Hospital of Erlangen, Krankenhausstrasse 12, 91054, Erlangen, Germany
| | - Torsten Birkholz
- Department of Anesthesiology, University Hospital of Erlangen, Krankenhausstrasse 12, 91054, Erlangen, Germany
| | - Horia Sirbu
- Department of Thoracic Surgery, University Hospital of Erlangen, Krankenhausstrasse 12, 91054, Erlangen, Germany
| | - Andrea Irouschek
- Department of Anesthesiology, University Hospital of Erlangen, Krankenhausstrasse 12, 91054, Erlangen, Germany
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Wanat-Hawthorne A, Stubblefield J, Lynch I, Dellaria S, Kernstine K. Successful Use of a Double Lumen Endotracheal Tube and Bronchial Blocker for Lung Isolation in Pulmonary Mucormycosis. J Cardiothorac Vasc Anesth 2019; 33:776-780. [DOI: 10.1053/j.jvca.2018.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Indexed: 11/11/2022]
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Falzon D, Alston PR, Coley E, Montgomery K. The Evidence is Out There; Let’s Keep on Looking For It Re: The Evidence-Base Surrounding Lung Isolation is Often Wider Than Described. J Cardiothorac Vasc Anesth 2018; 32:e15-e16. [DOI: 10.1053/j.jvca.2017.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Indexed: 11/11/2022]
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İlker Akçam T, Kavurmacı Ö, Özdil A, Ergönül AG, Turhan K, Çakan A. Larinks ve akciğer maligniteli olgularda akciğer rezeksiyonu. EGE TIP DERGISI 2017. [DOI: 10.19161/etd.395206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Zhang ZJ, Zheng ML, Nie Y, Niu ZQ. Comparison of Arndt-endobronchial blocker plus laryngeal mask airway with left-sided double-lumen endobronchial tube in one-lung ventilation in thoracic surgery in the morbidly obese. ACTA ACUST UNITED AC 2017; 51:e6825. [PMID: 29267506 PMCID: PMC5734186 DOI: 10.1590/1414-431x20176825] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 10/16/2017] [Indexed: 11/22/2022]
Abstract
This study aimed to evaluate the feasibility and performance of Arndt-endobronchial blocker (Arndt) combined with laryngeal mask airway (LMA) compared with left-sided double-lumen endobronchial tube (L-DLT) in morbidly obese patients in one-lung ventilation (OLV). In a prospective, randomized double-blind controlled clinical trial, 80 morbidly obese patients (ASA I-III, aged 20-70) undergoing general anesthesia for elective thoracic surgeries were randomly allocated into groups Arndt (n=40) and L-DLT (n=40). In group Arndt, a LMA™ Proseal was placed followed by an Arndt-endobronchial blocker. In group L-DLT, patients were intubated with a left-sided double-lumen endotracheal tube. Primary endpoints were the airway establishment, ease of insertion, oxygenation, lung collapse and surgical field exposure. Results showed similar ease of airway establishment and tube/device insertion between the two groups. Oxygen arterial pressure (PaO2) of patients in the Arndt group was significantly higher than L-DLT (154±46 vs 105±52 mmHg; P<0.05). Quality of lung collapse and surgical field exposure in the Arndt group was significantly better than L-DLT (effective rate 100 vs 90%; P<0.05). Duration of surgery and anesthesia were significantly shorter in the Arndt group (2.4±1.7 vs 3.1±1.8 and 2.8±1.9 vs 3.8±1.8 h, respectively; P<0.05). Incidence of hoarseness of voice and incidence and severity of throat pain at the post-anesthesia care unit and 12, 24, 48, and 72 h after surgery were significantly lower in the Arndt group (P<0.05). Findings suggested that Arndt-endobronchial blocker combined with LMA can serve as a promising alternative for morbidly obese patients in OLV in thoracic surgery.
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Affiliation(s)
- Z J Zhang
- Department of Anesthesiology, the Cangzhou Central Hospital, Cangzhou, Hebei, China
| | - M L Zheng
- Department of Anesthesiology, the Cangzhou Central Hospital, Cangzhou, Hebei, China
| | - Y Nie
- Department of Anesthesiology, the Cangzhou Central Hospital, Cangzhou, Hebei, China
| | - Z Q Niu
- Department of Anesthesiology, the Cangzhou Central Hospital, Cangzhou, Hebei, China
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Templeton TW, Morris BN, Goenaga-Diaz EJ, Forest DJ, Hadley R, Moore BA, Bryan YF, Royster RL. A Prospective Comparison of Intraluminal and Extraluminal Placement of the 9-French Arndt Bronchial Blocker in Adult Thoracic Surgery Patients. J Cardiothorac Vasc Anesth 2017; 31:1335-1340. [DOI: 10.1053/j.jvca.2017.02.188] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Indexed: 11/11/2022]
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Falzon D, Alston RP, Coley E, Montgomery K. Lung Isolation for Thoracic Surgery: From Inception to Evidence-Based. J Cardiothorac Vasc Anesth 2017; 31:678-693. [DOI: 10.1053/j.jvca.2016.05.032] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Indexed: 12/15/2022]
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Schlichting N, Flax K, Levine A, DeMaria S, Goldberg A. Thoracic Anesthesia: A Review of Current Topics and Debates. CURRENT ANESTHESIOLOGY REPORTS 2016. [DOI: 10.1007/s40140-016-0159-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Clayton-Smith A, Bennett K, Alston RP, Adams G, Brown G, Hawthorne T, Hu M, Sinclair A, Tan J. A Comparison of the Efficacy and Adverse Effects of Double-Lumen Endobronchial Tubes and Bronchial Blockers in Thoracic Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Trials. J Cardiothorac Vasc Anesth 2015; 29:955-66. [DOI: 10.1053/j.jvca.2014.11.017] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Indexed: 11/11/2022]
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Abhijit N, Venugopal K, Sunjoy V, Rajendra S, Rishidhar R. One lung ventilation in a patient with tracheostomy. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2015. [DOI: 10.1080/22201181.2015.1028223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Licker M, Le Guen M, Diaper J, Triponez F, Karenovics W. Isolation of the lung: Double-lumen tubes and endobronchial blockers. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2014. [DOI: 10.1016/j.tacc.2014.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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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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Kaza SR, Maddali MM, Albahrani MJ, Vaghari AA. One lung ventilation in a patient with an upper and lower airway abnormality. Indian J Anaesth 2013; 56:567-9. [PMID: 23325943 PMCID: PMC3546245 DOI: 10.4103/0019-5049.104578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
One-lung ventilation for a thoracotomy procedure was achieved with the help of a endobronchial blocker in a young girl with limited mouth opening, minimal neck extension, and a distorted tracheo-bronchial anatomy. As the patient would not cooperate for an awake nasotracheal intubation despite adequate preperation, an inhalational anesthetic was used to make the patient unconscious, taking care that spontaneous breathing was maintained. Nasotracheal intubation was done with the help of a fiberoptic bronchoscope. A wire-guided Arndt endobronchial blocker was placed coaxially through the endotracheal tube using a fiberoptic bronchoscope. This case report highlights that in a scenario of both upper and lower airway distortion, a bronchial blocker positioned through a nasotracheal tube under fiberoptic guidance might be the best option when one-lung ventilation is required.
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Seong YW, Yoo BS, Kim JT, Park IK, Kang CH, Kim YT. Video-Assisted Thoracoscopic Lobectomy in Children: Safety and Efficacy Compared with the Conventional Thoracotomy Approach. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2012; 7:394-8. [DOI: 10.1177/155698451200700604] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective There have been only small numbers of reports for video-assisted thoracoscopic surgery (VATS) lobectomy in children because of its technically demanding aspects. This study was performed to evaluate the safety and the efficacy of the VATS lobectomy compared with the conventional lobectomy by thoracotomy and to investigate the risk factors of thoracotomy conversion. Methods From May 2005 to October 2010, a total of 37 pediatric patients underwent VATS lobectomy and 28 pediatric patients underwent conventional lobectomy. The VATS lobectomy group consisted of relatively older patients compared with the thoracotomy group. Clinical outcomes from the two groups were analyzed and compared. Results Of the 37 patients in the VATS group, 8 patients (23%) required thoracotomy conversion and 29 patients (77%) were successfully operated on thoracoscopically. There were no in-hospital mortalities in both groups. Annual thoracotomy conversion rate has decreased from 50% in 2005 to 9% in 2010. There were no significant differences in the outcome between the VATS group and the thoracotomy group. Morbidities in the VATS group included prolonged drainage longer than 7 days (two patients), prolonged air leakage (two patients), and bleeding (one patient). There was no difference in the incidence of morbidities between the two groups. Univariate analyses revealed failure of single-lung ventilation (P = 0.007) and history of pneumonia (P = 0.001) to be risk factors of thoracotomy conversion. Conclusions Video-assisted thoracoscopic surgery lobectomy in children is a safe and effective treatment modality, with results comparable with those of conventional lobectomy. In the univariate analysis, failure of single-lung ventilation and history of pneumonia were the two factors related to thoracotomy conversion.
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Affiliation(s)
- Yong Won Seong
- Department of Thoracic and Cardiovascular Surgery, and Seoul National University Hospital, Seoul, Republic of Korea
| | - Byung Su Yoo
- Department of Thoracic and Cardiovascular Surgery, and Seoul National University Hospital, Seoul, Republic of Korea
| | - Jin Tae Kim
- Department of Anesthesiology, Clinical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
| | - In Kyu Park
- Department of Thoracic and Cardiovascular Surgery, and Seoul National University Hospital, Seoul, Republic of Korea
| | - Chang Hyun Kang
- Department of Thoracic and Cardiovascular Surgery, and Seoul National University Hospital, Seoul, Republic of Korea
| | - Young Tae Kim
- Department of Thoracic and Cardiovascular Surgery, and Seoul National University Hospital, Seoul, Republic of Korea
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23
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Ghosh S, Falter F, Klein AA, Arrowsmith JE. The Papworth BiVent tube: initial clinical experience. J Cardiothorac Vasc Anesth 2010; 25:505-8. [PMID: 20399118 DOI: 10.1053/j.jvca.2010.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2009] [Indexed: 11/11/2022]
Affiliation(s)
- Sunit Ghosh
- Department of Anaesthesia, Papworth Hospital, Cambridge, United Kingdom.
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