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Yu LS, Zhou SJ, Chen XH, Wang J, Wang ZC. Single-Lung Ventilation in Infants for Surgical Repair of Coarctation of The Aorta Without Cardiopulmonary Bypass. Braz J Cardiovasc Surg 2024; 39:e20220424. [PMID: 38629954 PMCID: PMC11020275 DOI: 10.21470/1678-9741-2022-0424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 09/08/2023] [Indexed: 04/19/2024] Open
Abstract
OBJECTIVE To investigate the effect of improving the operative field and postoperative atelectasis of single-lung ventilation (SLV) in the surgical repair of coarctation of the aorta (CoA) in infants without the use of cardiopulmonary bypass (CPB). METHODS This was a retrospective cohort study. The clinical data of 28 infants (aged 1 to 4 months, weighing between 4.2 and 6 kg) who underwent surgical repair of CoA without CPB from January 2019 to May 2022 were analyzed. Fourteen infants received SLV with a bronchial blocker (Group S), and the other 14 infants received routine endotracheal intubation and bilateral lung ventilation (Group R). RESULTS In comparison to Group R, Group S exhibited improved exposure of the operative field, a lower postoperative atelectasis score (P<0.001), reduced prevalence of hypoxemia (P=0.01), and shorter durations of operation, mechanical ventilation, and ICU stay (P=0.01, P<0.001, P=0.03). There was no difference in preoperative information or perioperative respiratory and circulatory indicators before SLV, 10 minutes after SLV, and 10 minutes after the end of SLV between the two groups (P>0.05). Intraoperative bleeding, intraoperative positive end-expiratory pressure (PEEP), and systolic pressure gradient across the coarctation after operation were also not different between the two groups (P>0.05). CONCLUSION This study demonstrates that employing SLV with a bronchial blocker is consistent with enhanced operative field, reduced operation duration, lower prevalence of intraoperative hypoxemia, and fewer postoperative complications during the surgical repair of CoA in infants without the use of CPB.
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Affiliation(s)
- Ling-Shan Yu
- Department of Cardiac Surgery, Fujian Children’s Hospital (Fujian
Branch of Shanghai Children’s Medical Center), College of Clinical Medicine for
Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Si-Jia Zhou
- Department of Cardiac Surgery, Fujian Children’s Hospital (Fujian
Branch of Shanghai Children’s Medical Center), College of Clinical Medicine for
Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Xiu-Hua Chen
- Department of Cardiac Surgery, Fujian Children’s Hospital (Fujian
Branch of Shanghai Children’s Medical Center), College of Clinical Medicine for
Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Jing Wang
- Department of Cardiac Surgery, Fujian Children’s Hospital (Fujian
Branch of Shanghai Children’s Medical Center), College of Clinical Medicine for
Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Zeng-Chun Wang
- Department of Cardiac Surgery, Fujian Children’s Hospital (Fujian
Branch of Shanghai Children’s Medical Center), College of Clinical Medicine for
Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
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2
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Öztürk L, Yiğit H. Preoperative preparation and postoperative care in children in thoracic surgery. Turk Gogus Kalp Damar Cerrahisi Derg 2024; 32:S1-S9. [PMID: 38584787 PMCID: PMC10995681 DOI: 10.5606/tgkdc.dergisi.2024.25708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 11/24/2023] [Indexed: 04/09/2024]
Abstract
Anesthesia for pediatric patients undergoing thoracic surgery continues to be distinctive due to differing anatomical and physiological characteristics compared to adults. Adequate preoperative preparation, appropriate tool selection for providing one-lung ventilation, perioperative pain management, and a multidisciplinary approach can ensure higher quality postoperative care. In this review, the perioperative anesthesia management for pediatric patients undergoing thoracic surgery will be discussed, starting from the preoperative preparation phase. Additionally, the issues related to the application and management of one-lung ventilation will also be assessed.
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Affiliation(s)
- Levent Öztürk
- Department of Anesthesiology and Reanimation, Bilkent City Hospital, Ankara, Türkiye
| | - Hülya Yiğit
- Department of Anesthesiology and Reanimation, Bilkent City Hospital, Ankara, Türkiye
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3
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Maddali MM, Al Wahaibi MMS, Patel MH, Zacharias S. Co-axial Endotracheal Tube Technique for Achieving One Lung Ventilation in a Toddler With a Space Occupying Malignant Tumor of the Right Lung. J Cardiothorac Vasc Anesth 2024; 38:243-247. [PMID: 37945408 DOI: 10.1053/j.jvca.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 09/28/2023] [Accepted: 10/04/2023] [Indexed: 11/12/2023]
Abstract
Achieving one-lung ventilation in pediatrics is often challenging. In caring for these patients, the anesthesiologist must consider the child's age and size, underlying tracheobronchial anatomy, equipment availability, urgency of procedure, and as well as the experience level of the anesthesiologist. This report describes a "tube-inside-tube" technique that was adopted for providing one-lung ventilation in a toddler. The method described here involved railroading a smaller endotracheal tube over a flexible intubation video endoscope into the left mainstem bronchus coaxially through a larger endotracheal tube placed in the trachea. The technique achieved effective left-lung ventilation and isolation of the operative right lung during surgical resection of a malignant mesenchymal tumor. On completion of the procedure, double-lung ventilation could be established through the endotracheal tube in the trachea after the retraction of the video endobronchial tube.
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Affiliation(s)
- Madan Mohan Maddali
- Department of Cardiac Anesthesia, National Heart Center, Royal Hospital, Muscat, Oman.
| | | | - Malay Hemantlal Patel
- Department of Cardiac Anesthesia, National Heart Center, Royal Hospital, Muscat, Oman
| | - Sunny Zacharias
- Department of Cardiothoracic Surgery, National Heart Center, Royal Hospital, Muscat, Oman
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4
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Gomes SH, Miranda A, Pêgo JM, Costa PS, Correia-Pinto J. Ultrasound-Guided Selective Bronchial Intubation: A Feasibility Study in Pediatric Animal Model. Front Med (Lausanne) 2022; 9:869771. [PMID: 35783614 PMCID: PMC9240755 DOI: 10.3389/fmed.2022.869771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 05/16/2022] [Indexed: 11/18/2022] Open
Abstract
Objective Selective one-lung ventilation used to optimize neonatal and pediatric surgical conditions is always a demanding task for anesthesiologists, especially during minimally invasive thoracoscopic surgery. This study aims to introduce an ultrasound-guided bronchial intubation and exclusion technique in a pediatric animal model. Methods Seven rabbits were anesthetized and airway ultrasound acquisitions were done. Results Tracheal tube progression along the trachea to the right bronchus and positioning of the bronchial blocker in the left bronchus were successfully done with consistent ultrasound identification of relevant anatomical structures. Conclusion The study provided a new application of ultrasound in airway management. More advanced experimental studies are needed since this technique has the potential for translation to pediatric anesthesia.
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Affiliation(s)
- Sara Hora Gomes
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B’s-PT Government Associate Laboratory, Braga, Portugal
- *Correspondence: Sara Hora Gomes,
| | - Alice Miranda
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B’s-PT Government Associate Laboratory, Braga, Portugal
| | - José Miguel Pêgo
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B’s-PT Government Associate Laboratory, Braga, Portugal
| | - Patrício S. Costa
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B’s-PT Government Associate Laboratory, Braga, Portugal
| | - Jorge Correia-Pinto
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B’s-PT Government Associate Laboratory, Braga, Portugal
- Department of Pediatric Surgery, Hospital de Braga, Braga, Portugal
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5
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Behera B, Misra S, Mohanty M, Tripathy B. Use of Fogarty catheter as bronchial blocker for lung isolation in children undergoing thoracic surgery: A single centre experience of 15 cases. Ann Card Anaesth 2022; 25:148-152. [PMID: 35417959 PMCID: PMC9244278 DOI: 10.4103/aca.aca_219_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Background and Aim: Various devices such as single lumen tubes, balloon-tipped bronchial blockers, and double-lumen tubes can be used for lung isolation in children, but no particular device is ideal. As such, there is a wide variation in lung isolation techniques employed by anaesthesiologists in this cohort of patients. This study aims to describe our experience with Fogarty catheters for lung isolation in children. Methods: This was a single centre, retrospective review of 15 children, below the age of 8 years, undergoing thoracic surgeries and requiring lung isolation. Demographic details, clinical parameters, complications during Fogarty catheter placement, number of attempts for placement, time taken for satisfactory lung isolation, and intraoperative complications were collected. Results: Successful lung isolation was achieved in all 15 children with Fogarty catheters of various sizes with the help of flexible bronchoscopy. Desaturation and bradycardia were the commonest complications seen during placement of the catheters but resolved with bag-mask ventilation. On average, 2 attempts were required for successful Fogarty placement. The mean time for successful lung isolation was 6.9 ± 1.3 minutes. The commonest intraoperative complication noted was desaturation, which resolved with an increase in FiO2and positive end expiratory pressure. 2 children had migration of the device proximally to the trachea causing airway obstruction. The devices were successfully repositioned in both cases. Conclusion: Fogarty catheters can be used for successful lung isolation in children less than 8 years of age, undergoing thoracic surgery.
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Sankaran D, Hirose S, Null DM, Ravula NR, Lakshminrusimha S. Novel Use of a Bronchial Blocker in a Challenging Case of Congenital Diaphragmatic Hernia—A Case Report. Children 2021; 8:children8121163. [PMID: 34943358 PMCID: PMC8700282 DOI: 10.3390/children8121163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 12/07/2021] [Accepted: 12/08/2021] [Indexed: 11/23/2022]
Abstract
The diagnosis of congenital diaphragmatic hernia (CDH) is associated with significant morbidity and mortality. Survival of neonates with CDH has improved recently, although the clinical course is complicated by sequelae of hypoplastic pulmonary parenchyma and vasculature, pulmonary hypertension, ventilation/perfusion (V/Q) mismatch, reduced pulmonary function and poor somatic growth. In this case report, we describe an infant with an antenatal diagnosis of CDH with a poor prognosis who underwent initial surgery followed by a tracheostomy but had a worsening clinical course due to a large area of ventilated but poorly perfused lung based on a V/Q nuclear scintigraphy scan. The emphysematous left lung was causing mediastinal shift and compression of the right lung, further compromising gas exchange. The infant had clinical improvement following bronchial blockade of the under-perfused left lung. This paved the way for further management with resection of the under-perfused lung lobe and continued clinical improvement. We present the novel use of selective bronchial blockade in a challenging case of CDH to determine if surgical lung resection may benefit the infant. We also review the physiology of gas exchange during the use of a bronchial occluder and the relevant literature.
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Affiliation(s)
- Deepika Sankaran
- Division of Neonatology, Department of Pediatrics, University of California at Davis, Davis, CA 95817, USA; (D.M.N.); (S.L.)
- Correspondence:
| | - Shinjiro Hirose
- Division of Pediatric Surgery, Department of Pediatrics, University of California at Davis, Davis, CA 95817, USA;
| | - Donald Morley Null
- Division of Neonatology, Department of Pediatrics, University of California at Davis, Davis, CA 95817, USA; (D.M.N.); (S.L.)
| | - Niroop R. Ravula
- Division of Pediatric Anesthesiology, Department of Anesthesiology and Pain Medicine, University of California at Davis, Davis, CA 95817, USA;
| | - Satyan Lakshminrusimha
- Division of Neonatology, Department of Pediatrics, University of California at Davis, Davis, CA 95817, USA; (D.M.N.); (S.L.)
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7
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Murray-Torres TM, Winch PD, Naguib AN, Tobias JD. Anesthesia for thoracic surgery in infants and children. Saudi J Anaesth 2021; 15:283-299. [PMID: 34764836 PMCID: PMC8579498 DOI: 10.4103/sja.sja_350_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 04/21/2020] [Indexed: 11/19/2022] Open
Abstract
The management of infants and children presenting for thoracic surgery poses a variety of challenges for anesthesiologists. A thorough understanding of the implications of developmental changes in cardiopulmonary anatomy and physiology, associated comorbid conditions, and the proposed surgical intervention is essential in order to provide safe and effective clinical care. This narrative review discusses the perioperative anesthetic management of pediatric patients undergoing noncardiac thoracic surgery, beginning with the preoperative assessment. The considerations for the implementation and management of one-lung ventilation (OLV) will be reviewed, and as will the anesthetic implications of different surgical procedures including bronchoscopy, mediastinoscopy, thoracotomy, and thoracoscopy. We will also discuss pediatric-specific disease processes presenting in neonates, infants, and children, with an emphasis on those with unique impact on anesthetic management.
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Affiliation(s)
- Teresa M Murray-Torres
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, Missouri, USA.,Department of Anesthesiology, St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Peter D Winch
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, Missouri, USA.,Department of Anesthesiology and Pain Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Aymen N Naguib
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, Missouri, USA.,Department of Anesthesiology and Pain Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Joseph D Tobias
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, Missouri, USA.,Department of Anesthesiology and Pain Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA
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8
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Xu Y, Li L, Hou J, Zhang N, Zeng M, Qiu Q, Liang Y, Wei W, Tan Y. 3D CT airway evaluation-guided intraluminal placement of endobronchial blocker in pediatric patients: a randomized controlled study. Transl Pediatr 2021; 10:625-634. [PMID: 33850821 PMCID: PMC8039777 DOI: 10.21037/tp-21-33] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The aim of the present study was to propose a new approach for 3D computed tomography (CT) airway evaluation-guided endobronchial blocker placement in pediatric patients, and to determine its efficiency in clinical application. METHODS A total of 127 pediatric patients aged 0.5-3 years who were scheduled for elective thoracic surgery using one-lung ventilation (OLV) were randomized into the bronchoscopy (BRO) group and the CT group. The degree of lung collapse, postoperative airway mucosal injury, pulmonary infection within 72 h after surgery, and hoarseness after tracheal extubation; duration of postoperative mechanical ventilation, intensive care unit (ICU) stay and hospitalization; success rate of first blocker positioning; and required time and repositioning for successful blocker placement were compared between the 2 groups. RESULTS The degree of lung collapse, postoperative airway mucosal injury, pulmonary infection within 72 h after surgery, and hoarseness after tracheal extubation; duration of postoperative mechanical ventilation, ICU stay and hospitalization; success rate of first blocker positioning; and required time and repositioning for successful blocker placement were similar between the 2 groups (all P>0.05). CONCLUSIONS For pediatric patients undergoing surgery with OLV, preoperative 3D CT airway evaluation could be used to guide endobronchial blocker placement, with a blocking efficiency similar to that of BRO-guided blocker placement.
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Affiliation(s)
- Yingyi Xu
- Department of Anesthesiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Le Li
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Jianning Hou
- Department of Radiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Na Zhang
- Department of Anesthesiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Minting Zeng
- Department of Anesthesiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Qianqi Qiu
- Department of Anesthesiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Yufeng Liang
- Pediatric Intensive Care Unit, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Wei Wei
- Department of Anesthesiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Yonghong Tan
- Department of Anesthesiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
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9
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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10
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Zhang L, Wang YP, Chen XF, Yan ZR, Zhou M. Effects of bronchial blockers on gas exchange in infants with one-lung ventilation: a single-institutional experience of 22 cases. Transl Pediatr 2020; 9:802-808. [PMID: 33457302 PMCID: PMC7804471 DOI: 10.21037/tp-20-391] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND One-lung ventilation (OLV) in infants is a commonly used airway technique during thoracic surgery. Current research has primarily focused on the operation of the airways and the occurrence of complications. However, there has been minimal data on the pulmonary gas exchange in infants before and after OLV. This study aimed to assess the efficacy of bronchial blockers (BBs) on the pulmonary gas exchange in infants with OLV. METHODS A total of 22 infants requiring OLV from January 2017 to August 2019 were included in this study. OLV was achieved by placing BBs outside the endotracheal tube, and all surgeries were performed by the same experienced anesthesiologist. Numerous clinical features, including the oxygenation index (OI), alveolar-arterial oxygen tension gradient (PA-aO2), pulmonary dynamic compliance (Cdyn), OLV time, pulmonary collapse time, degree of pulmonary collapse at the operative side, operative time, and immediate hemodynamic indexes before and after intubation were assessed. Data from the arterial blood gases and the ventilator's parameters were obtained at three time points: 15 minutes before OLV (pre-OLV), 15 minutes after the initiation of OLV (during OLV), and 15 minutes after the termination of OLV (post-OLV). RESULTS For all patients, the pulmonary gas exchange during OLV was significantly different from both pre-OLV and post-OLV. However, no significant changes of pulmonary function were observed before and after OLV. Extended OLV time was associated with decreased OI and Cdyn, and increased PA-aO2 gradient (P<0.001). In addition, no significant changes of hemodynamic indexes before and after intubation were detected. The degree of lung collapse on the operational side during OLV was optimal. CONCLUSIONS In this study, the efficacy of BBs on the pulmonary gas exchange in infants with OLV was assessed. The results suggested that although each parameter of pulmonary function pre-OLV were similar to those of post-OLV, an extended period of OLV may lead to compromised lung function.
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Affiliation(s)
- Li Zhang
- Department of Anesthesiology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Yu-Ping Wang
- Department of Anesthesiology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Xiao-Fen Chen
- Department of Anesthesiology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Zi-Rogn Yan
- Department of Anesthesiology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Min Zhou
- Department of Anesthesiology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China
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11
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Goetschi M, Kemper M, Dave MH, Kleine-Brueggeney M, Henze G, Weiss M. Dimensional compatibility of balloon-tipped bronchial blockers with the pediatric airway anatomy using different recommendations for age-related size selection. Paediatr Anaesth 2020; 30:1245-1253. [PMID: 32688433 DOI: 10.1111/pan.13973] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 07/08/2020] [Accepted: 07/13/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Age-related recommendations for size selection of bronchial blocker devices are based on a few dated anatomical autopsy and radiological studies determining lower airway dimensions in children. These recommendations are based on anterior-posterior internal bronchial diameters, which are smaller than the more relevant lateral internal bronchial diameters. METHODS Outer diameters of bronchial blocker balloons inflated with the maximum recommended volume of air were compared to age-related lateral internal bronchial diameters of left and right proximal mainstem bronchi using five different recommendations for age-related size selection of bronchial blocker equipment in children published in the literature. RESULTS The ratio of outer bronchial blocker diameters inflated with the maximal recommended volume of air to the median lateral internal diameters of the proximal mainstem bronchus ranged from 71.4% to 181.8% for the left side and from 61.7% to 162.6% for the right side. There were many settings where the blocker diameters did not reach the median lateral internal diameters of the proximal mainstem bronchus. This was more often observed for the right than for the left side (37 vs 22 settings). CONCLUSION This analysis demonstrates that irrespective of the recommendation for size selection used, neither the two balloon-tipped vascular catheters included nor the Arndt endobronchial blockers are ideal for lung isolation in children are compared with the age-related relevant dimensions of pediatric airway anatomy. A redesign of bronchial blocker equipment with age-related anatomically based high-volume, low-pressure blocker balloons made from ultrathin membranes and with smaller catheters would be desirable.
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Affiliation(s)
- Markus Goetschi
- Department of Anesthesia, University Children's Hospital Zurich, Zurich, Switzerland
| | - Michael Kemper
- Department of Anesthesia, University Children's Hospital Zurich, Zurich, Switzerland
| | - Mital H Dave
- Department of Anesthesia, University Children's Hospital Zurich, Zurich, Switzerland
| | | | - Georg Henze
- Department of Anesthesia, University Children's Hospital Zurich, Zurich, Switzerland
| | - Markus Weiss
- Department of Anesthesia, University Children's Hospital Zurich, Zurich, Switzerland
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12
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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13
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Yan J, Rufang Z, Rong W, Wangping Z. Extraluminal Placement of the Bronchial Blocker in Infants Undergoing Thoracoscopic Surgery: A Randomized Controlled Study. J Cardiothorac Vasc Anesth 2020; 34:2435-2439. [PMID: 32178953 DOI: 10.1053/j.jvca.2020.02.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 01/30/2020] [Accepted: 02/05/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The purpose of the present study was to evaluate the efficacy of extraluminal use of the bronchial blocker (BB) for one-lung ventilation (OLV) in infants undergoing thoracoscopic surgery. DESIGN This was a prospective, randomized, controlled clinical study. SETTING University hospital. PARTICIPANTS The study comprised 60 infants undergoing thoracoscopic surgery. INTERVENTION The study included 2 groups. A BB was placed extraluminally for OLV in group A, and a single-lumen endobronchial tube was inserted into the desired mainstem bronchus for OLV in group C. MEASUREMENTS AND MAIN RESULTS The placement time (4.0 ± 0.6 min v 6.3 ± 4.1 min; p = 0.04) and the number of repositions (2 v 11; p = 0.005) were less in group A. There were significant differences in the heart rate and blood pressure after insertion between the 2 groups (p < 0.05). The tidal volumes and end-tidal pressure of carbon dioxide values 10 minutes after the initiation of OLV were similar between the 2 groups (p > 0.05). The incidence of intraoperative hypoxemia was reduced in group A compared with group C (0% v 20%; p = 0.024). No postoperative adverse events were observed in either group. CONCLUSIONS Extraluminal use of the BB may provide a solution for a rapid placement and excellent quality of lung isolation, and it may reduce the incidence of intraoperative hypoxemia in infants without increasing the incidence of hoarseness.
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Affiliation(s)
- Jiang Yan
- Department of Anesthesiology, Shanghai Children's Hospital, Shanghai JiaoTong University, Shanghai, China
| | - Zhang Rufang
- Department of Cardiothoracic Surgery, Shanghai Children's Hospital, Shanghai JiaoTong University, Shanghai, China
| | - Wei Rong
- Department of Anesthesiology, Shanghai Children's Hospital, Shanghai JiaoTong University, Shanghai, China.
| | - Zhang Wangping
- Department of Anesthesiology, Women and Children's Hospital of Jiaxing University, Jiaxing, China
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Abstract
INTRODUCTION Attaining lung isolation in the infant is a challenge for anesthesia care providers. Pulmonary lobe isolation is more challenging. We describe an approach to performing selective pulmonary lobe isolation using the pediatric endobronchial blocker in an infant in the absence of appropriate auxiliary guidance tool. PATIENT CONCERNS An 8-month-old and 9.5 kg male infant was admitted because of repeated cough with fever for 3 months and a large cyst of his right lung for 2 weeks. He had been living in a pastoral area with his parents. DIAGNOSIS Based on the chest computed tomography (CT) and his history about long-term residence in the pastoral area, this patient's diagnosis was considered as right middle lobe hydatid cyst. INTERVENTIONS Guided by a fiberoptic bronchoscope, a cuffed 4.0-mm inside diameter (ID) endotracheal tube was successfully placed into the right main bronchus of this infant. Then, pediatric 5-French (Fr) endobronchial blocker was placed into the right middle and lower lobes through the endotracheal tube without navigation of fiberoptic bronchoscope. OUTCOMES Lobe isolation was successfully achieved for right middle lobectomy. This approach allows clinicians to perform lobe isolation in the absence of fiberoptic bronchoscope with very small outer diameter. CONCLUSION This technique is relatively easy to use and less dependent on equipment with small outer diameter in the selective pulmonary lobe isolation in infants and small children.
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Mohtar S, Hui TWC, Irwin MG. Anesthetic management of thoracoscopic resection of lung lesions in small children. Paediatr Anaesth 2018; 28:1035-1042. [PMID: 30281181 DOI: 10.1111/pan.13502] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 08/29/2018] [Accepted: 08/29/2018] [Indexed: 01/06/2023]
Abstract
BACKGROUND Video-assisted thoracoscopic surgery has dramatically increased over the last decade because of both medical and cosmetic benefits. Anesthesia for video-assisted thoracoscopic surgery in small children is more challenging compared to adults due to the considerable problems posed by small airway dimensions and ventilation. The optimal technique for one-lung ventilation has yet to be established and the use of remifentanil infusion in this setting is not well described. AIMS This study investigated the use of extraluminal bronchial blocker placement for one-lung ventilation and the effect of infusion of remifentanil in infants and small children undergoing video-assisted thoracoscopic surgery. METHODS We retrospectively reviewed the technique of one-lung ventilation and the hemodynamic effects of remifentanil infusion in 31 small children during elective video-assisted thoracoscopic surgery for congenital lung lesions under anesthesia with sevoflurane or isoflurane, oxygen, and air. Patients' heart rate, blood pressure, and endtidal carbon dioxide at baseline (after induction of anesthesia), immediately after one-lung ventilation, during carbon dioxide insufflation, and at the end of one-lung ventilation were extracted from the database and analyzed. The use of vasopressors or dexmedetomidine was also recorded and analyzed. RESULTS Extraluminal placement of a bronchial blocker alongside the tracheal tube was successfully performed in 90.3% of cases (28 patients) without any serious complications or arterial oxygen desaturation. There was no significant rise in blood pressure or heart rate even with the rise of endtidal carbon dioxide concentration during video-assisted thoracoscopic surgery. In 58% of patients (18 patients), phenylephrine was administered to maintain the blood pressure within 20% of the baseline value. There was no significant change in the heart rate of all patients at each time point. CONCLUSION One-lung ventilation with an extraluminal parallel blocker was used effectively in this series of young children undergoing thoracoscopic excision of congenital pulmonary lesions. Remifentanil infusion attenuated surgical stress effectively in infants and small children undergoing video-assisted thoracoscopic surgery.
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Affiliation(s)
- Sanah Mohtar
- Department of Anesthesia and Intensive Care, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Theresa W C Hui
- Department of Anaesthesiology, Queen Mary Hospital, Hong Kong, China
| | - Michael G Irwin
- Department of Anaesthesiology, University of Hong Kong, Hong Kong, China
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Semmelmann A, Kaltofen H, Loop T. Reply to Ho, Anthony; Mizubuti, Glenio; Dion, Joanna, regarding their comments "Comments on 'Anesthesia of thoracic surgery in children'". Paediatr Anaesth 2018; 28:679-680. [PMID: 30133909 DOI: 10.1111/pan.13426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Axel Semmelmann
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center, Freiburg, Germany
| | - Heike Kaltofen
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center, Freiburg, Germany
| | - Torsten Loop
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center, Freiburg, Germany
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Guo X, Song X, Chen X, Liu W, Wang H, Xia H. A novel technique for endobronchial blocker placement for one-lung ventilation in children under 2 years. Acta Anaesthesiol Scand 2018; 62:765-772. [PMID: 29512132 DOI: 10.1111/aas.13099] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 01/04/2018] [Accepted: 02/11/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND The present study aimed to report our clinical experience with intraluminal calculated distance for endobronchial blocker placement (ICEB) and to find out whether ICEB could reduce the number of hypoxemia episodes during blocker placement compared with extraluminal blocker placement for one-lung ventilation in children under the age of 2 years. METHODS The medical records of all children under the age of 2 years with a 5 French (F) or 4F WeiLi (WeiLi medical Inc, Guangzhou, China) endobronchial blocker for one-lung ventilation in thoracic surgery from July 2015 through July 2016 were retrospectively reviewed. After November 2015, one-lung ventilation was achieved using the ICEB technique, while before November 2015, extraluminal blocker placement was used. The success rate of blocker placement, quality of lung deflation, number of hypoxemia episodes, blocker dislodgement, and successful reposition after dislodgement were compared between the two groups. RESULT The incidence of hypoxemia episodes during blocker placement was lower in the ICEB group compared to the extraluminal placement group. Moreover, the success rate of blocker reposition during the operation was higher in the ICEB group than the extraluminal placement group. The success rate of endobronchial blocker placement was similar between the two groups. CONCLUSIONS Intraluminal calculated distance for endobronchial blocker placement is a feasible method to achieve lung isolation and could reduce hypoxemia episodes during blocker placement in children under the age of 2 years.
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Affiliation(s)
- X. Guo
- Department of Anesthesia; Guangzhou Women and Children's Medical Center; Guangzhou Guangdong China
| | - X. Song
- Department of Anesthesia; Guangzhou Women and Children's Medical Center; Guangzhou Guangdong China
| | - X. Chen
- Department of Anesthesia; Guangzhou Women and Children's Medical Center; Guangzhou Guangdong China
| | - W. Liu
- Department of Pediatric Surgery; Guangzhou Women and Children's Medical Center; Guangzhou Guangdong China
| | - H. Wang
- Department of Pediatric Surgery; Guangzhou Women and Children's Medical Center; Guangzhou Guangdong China
| | - H. Xia
- Department of Anesthesia; Guangzhou Women and Children's Medical Center; Guangzhou Guangdong China
- Department of Pediatric Surgery; Guangzhou Women and Children's Medical Center; Guangzhou Guangdong China
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Moritz A, Irouschek A, Birkholz T, Prottengeier J, Sirbu H, Schmidt J. The EZ-blocker for one-lung ventilation in patients undergoing thoracic surgery: clinical applications and experience in 100 cases in a routine clinical setting. J Cardiothorac Surg 2018; 13:77. [PMID: 29940993 PMCID: PMC6019220 DOI: 10.1186/s13019-018-0767-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 06/19/2018] [Indexed: 01/12/2023] Open
Abstract
Background In certain clinical situations the insertion of a double-lumen tube (DLT) for one-lung ventilation (OLV) is not feasible or unfavorable. In these cases, the EZ-Blocker (EZB) may serve as an alternative. The aim of our analysis was to report on the clinical applications and our experience with the EZB for one-lung ventilation in 100 patients undergoing thoracic surgery. Methods All anesthetic records from patients older than 18 years of age undergoing general anesthesia in the department of thoracic surgery with intraoperative use of an EZB for OLV at the University Hospital of Erlangen in four consecutive years were analyzed retrospectively. Results Most frequently, EZB was used in difficult airway (27%) and for surgical procedures with high risk for left recurrent laryngeal nerve injury (21%), followed by application in intubated (12%) or tracheostomized (11%) patients. 11% of the patients had an increased risk of gastric regurgitation. Almost all EZBs were placed free of complications (99%). Clinically sufficient lung collapse was achieved in all patients. No serious airway injuries or immediate complications were documented. Conclusions The EZB is an efficient, easy-to-use and safe airway device and enables OLV in several clinical situations, when conventional DLTs are not feasible or less favorable. Three major applications were depicted from the data: expected difficult airway, surgical procedures with necessity of intraoperative recurrent laryngeal nerve monitoring and already intubated or tracheostomized patients.
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Affiliation(s)
- Andreas Moritz
- Department of Anesthesiology, University Hospital of Erlangen, Krankenhausstrasse 12, 91054, Erlangen, Germany.
| | - Andrea Irouschek
- Department of Anesthesiology, University Hospital of Erlangen, Krankenhausstrasse 12, 91054, Erlangen, Germany
| | - Torsten Birkholz
- Department of Anesthesiology, University Hospital of Erlangen, Krankenhausstrasse 12, 91054, Erlangen, Germany
| | - Johannes Prottengeier
- 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
| | - Joachim Schmidt
- Department of Anesthesiology, University Hospital of Erlangen, Krankenhausstrasse 12, 91054, Erlangen, Germany
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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] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Indexed: 12/15/2022]
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21
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Kamra SK, Jaiswal AA, Garg AK, Mohanty MK. Rigid Bronchoscopic Placement of Fogarty Catheter as a Bronchial Blocker for One Lung Isolation and Ventilation in Infants and Children Undergoing Thoracic Surgery: A Single Institution Experience of 27 Cases. Indian J Otolaryngol Head Neck Surg 2016; 69:159-171. [PMID: 28607884 DOI: 10.1007/s12070-016-1026-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 10/05/2016] [Indexed: 11/30/2022] Open
Abstract
One-lung ventilation (OLV) is a challenging task in infants and children as few techniques are possible because of narrow anatomy. The aim of this study is to evaluate and experience lung isolation with Fogarty catheters as a bronchial blocker placed by rigid bronchoscope for OLV in infants and children with lung pathologies requiring surgical management in an industrial hospital. This study is a prospective study carried out in J.L.N. Hospital and Research Centre, Bhilai (CG), from January 2011 to December 2014. The study was designed to place Fogarty catheter for achieving OLV using rigid bronchoscope in children. The patient and anaesthesia characteristics, placement and positioning of Fogarty catheters, intraoperative course, complications and recovery of the patient were studied. The data were then compared with the relevant and available literature. Over the study period of 4 years, 27 cases were included, out of which 22 (81.48 %) cases had suppurative lung disease, three cases (11.11 %) had hydatid cyst of the lung, whereas one case (3.7 %) each of congenital lobar emphysema and congenital cystic adenomatoid malformation of the lung, respectively. In all cases general anaesthesia was provided using single lumen endotracheal tube and one lung ventilation achieved by parallel placement of Fogarty catheter as a bronchial blocker with rigid bronchoscope. The surgical management included thoracotomy with decortication in 21 cases, thoracotomy with excision of hydatid cyst in 3 cases, video-assisted thoracoscopic surgery, thoracotomy with left upper lobectomy and thoracotomy with left lower lobectomy in one case each, respectively. There were no major intraoperative and postoperative complications. There was no mortality in our study. We conclude that rigid bronchoscope can be safely and effectively used to place Fogarty catheter in main bronchus in infants and children for achieving OLV.
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Affiliation(s)
- Sunil Kant Kamra
- Department of Anaesthesia, J.L.N. Hospital and Research Centre, Bhilai, CG India
| | - Ashwin Ashok Jaiswal
- Department of ENT and Head Neck Surgery, J.L.N. Hospital and Research Centre, Sector 9, Bhilai, Dist. Durg, CG 490009 India
| | - Amrish Kumar Garg
- Department of ENT and Head Neck Surgery, J.L.N. Hospital and Research Centre, Sector 9, Bhilai, Dist. Durg, CG 490009 India
| | - Manoj Kumar Mohanty
- Department of Paediatric Surgery, J.L.N. Hospital and Research Centre, Bhilai, CG India
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Liang P, Ni J, Zhou C, Yu H, Liu B. Efficacy of a New Blind Insertion Technique of Arndt Endobronchial Blocker for Lung Isolation: Comparison With Conventional Bronchoscope-Guided Insertion Technique-A Pilot Study. Medicine (Baltimore) 2016; 95:e3687. [PMID: 27175708 PMCID: PMC4902550 DOI: 10.1097/md.0000000000003687] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
This study aimed to find other methods of blind insertion of Arndt endobronchial blocker (AEB) for lung isolation when a fiberoptic bronchoscope (FOB) is unavailable.We compared the effectiveness and safety of 3 insertion techniques of AEB: Gum elastic bougie (GEB)-, bougie combined with cricoid displacing (BCD)-, and fiberoptic bronchoscope (FOB)-guided insertion. Seventy-eight patients undergoing esophageal procedure and requiring left thoracotomy were randomly assigned to 1 of 3 groups: GEB group, BCD group, and FOB group. We recorded the successful placement of AEBs at first attempt, placement time, malposition of AEBs in supine and lateral decubitus position, the bronchus injury score, and other complications.The successful placement of AEB for the first attempt was 22/26, 25/26, and 26/26 patients in GEB, BCD, and FOB groups, respectively. The placement times in GEB and BCD groups were longer than those in the FOB group (P < 0.05). AEB malposition occurred in 1/26, 2/26, 1/26 patients after lateral decubitus position, and AEBs were repositioned in 5/26, 3/26, 1/26 patients by FOB due to poor lung isolation in GEB, BCD, and FOB groups, respectively. There was no difference for the bronchus injury scores and other complications among 3 groups (P > 0.05).Bougie and cricoid displacing-guided blind insertion of AEB seems to be a novel method, which is an effective and safe alternative when FOB was unavailable.
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Affiliation(s)
- Peng Liang
- From the Department of Anesthesiology (PL, HY, BL), Laboratory of Anesthesia & CCM, Translational Neuroscience Center (CZ), West China Hospital, Sichuan University; Department of Anesthesiology, West China Second Hospital, Sichuan University (JN); Chengdu, Sichuan, China
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Templeton TW, Downard MG, Simpson CR, Zeller KA, Templeton LB, Bryan YF. Bending the rules: a novel approach to placement and retrospective experience with the 5 French Arndt endobronchial blocker in children <2 years. Paediatr Anaesth 2016; 26:512-20. [PMID: 26956889 DOI: 10.1111/pan.12882] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/14/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND One-lung ventilation (OLV) is frequently employed to improve surgical exposure during video-assisted thoracoscopic surgery (VATS) and thoracotomy in adults and children. Because of their small size, children under the age of 2 years are not candidates for some of the methods typically used for OLV in adults and older children, such as a double-lumen endotracheal (DLT) tube or intraluminal use of a bronchial blocker. Due to this, the clinician is left with few options. One of the most robust approaches to OLV in infants and small children has been the extraluminal placement of a 5 French (5F) Arndt endobronchial blocker (AEB). AIM The aim of this retrospective study was to examine and describe our experience with placement and management of an extraluminal 5F AEB for thoracic surgery in children <2 years of age. METHODS We retrospectively examined the anesthetic records for details of AEB placement, arterial blood gas (ABG) data, and intraoperative analgesic prescription in 15 children under the age of 2 years undergoing OLV with a 5F AEB for thoracic surgery at our institution from January 2010 through January 2016. RESULTS We were able to successfully achieve lung isolation in 14 of 15 patients using a 5F AEB that was bent 35-45° 1.5 cm proximal to the inflatable cuff. In 13 of 15 patients, we were able to place the AEB into final position with the aid of video-assisted fiberoptic bronchoscopy. In two patients, fluoroscopy was required to place the 5F AEB into the left mainstem due to poor visualization of the carina and rapid desaturation during bronchoscopy. In one of these patients, even though the blocker appeared to be correctly placed by fluoroscopy, adequate lung isolation was not observed. Intraoperatively, we observed significant degrees of hypercarbia in most patients without oxygen desaturation. Analgesic regimens lacked consistency and varied among patients. Open thoracotomy procedures tended to receive more aggressive narcotic regimens than video-assisted thoracoscopic surgery (VATS) procedures. Fourteen of 15 patients were extubated in the immediate postoperative period. CONCLUSIONS Our technique of placing a 35-45° bend in the AEB, extraluminal placement, and observed manipulation with a video-assisted flexible fiberoptic bronchoscope (FFB) within the trachea can be used to achieve consistent lung isolation in patients <2 undergoing thoracic surgery. When the use of a FFB proves unsuccessful, fluoroscopy can provide an alternative solution to successful placement. Significant respiratory derangements without long-term sequelae will occur in a majority of these patients during OLV. Several different approaches to intraoperative analgesia did not impede extubation in the early postoperative period.
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Affiliation(s)
- T Wesley Templeton
- Department of Anesthesiology Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, USA
| | - Martina G Downard
- Department of Anesthesiology Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, USA
| | - Christopher R Simpson
- Department of Anesthesiology Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, USA
| | - Kristen A Zeller
- Department of Pediatrics (Section on Pediatric Surgery), Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, USA
| | - Leah B Templeton
- Department of Anesthesiology Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, USA
| | - Yvon F Bryan
- Department of Anesthesiology Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, USA
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Cerchia E, Ferrero L, Molinaro F, Donato L, Messina M, Becmeur F. Pediatric Thoracoscopy and Bronchial Blockers: The Continued Search for the Ideal One-Lung Ventilation. J Laparoendosc Adv Surg Tech A 2016; 26:153-6. [DOI: 10.1089/lap.2015.0235] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Elisa Cerchia
- Pediatric Surgery Unit, Department of Medical Sciences, Surgery, and Neuroscience, University of Siena, Siena, Italy
| | - Luisa Ferrero
- Department of Pediatric Surgery, University Hospital of Strasbourg, Hautepierre Hospital, Strasbourg, France
| | - Francesco Molinaro
- Pediatric Surgery Unit, Department of Medical Sciences, Surgery, and Neuroscience, University of Siena, Siena, Italy
| | - Lionel Donato
- Department of Pediatric Surgery, University Hospital of Strasbourg, Hautepierre Hospital, Strasbourg, France
| | - Mario Messina
- Pediatric Surgery Unit, Department of Medical Sciences, Surgery, and Neuroscience, University of Siena, Siena, Italy
| | - François Becmeur
- Department of Pediatric Surgery, University Hospital of Strasbourg, Hautepierre Hospital, Strasbourg, France
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Affiliation(s)
- Vincent C Hsieh
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle Children's Hospital, Seattle, WA, USA.
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Abstract
The advantages of video assisted thoracoscopic surgery (VATS) in children have led to its increased usage over the years. VATS, however, requires an efficient technique for one lung ventilation. Today, there is an increasing interest in developing the technique for lung isolation to meet the anatomic and physiologic variations in infants and children. This article aims to provide an updated and comprehensive review on one-lung ventilation strategies for infants and children undergoing VATS. Search of terms such as ‘One lung ventilation for infants and children’, ‘Video assisted thoracoscopic surgery for infants and children’, and ‘Physiologic changes during one lung ventilation for infants and children’ were used. The search mechanics and engines for this review included the following: Kandang Kerbau Hospital (KKH) eLibrary, PubMed, Ovid Medline, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews. During the search the author focused on significant current and pilot randomized control trials, case reports, review articles, and editorials. Critical decision making on what device to use based on the age, weight, and pathology of the patient; and how to use it for lung isolation are discussed in this article. Furthermore, additional information regarding the advantages, limitations, techniques of insertion and maintenance of each device for one lung ventilation in infants and children were the highlights in this article.
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Affiliation(s)
- Teddy Suratos Fabila
- Department of Paediatric Anaesthesia, Kandang Kerbau Women's and Children's Hospital, 100 Bukit Timah Road, Singapore
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Seok JH, Kim EJ, Ban JS, Lee SG, Lee JH, Seo DM, Shim KS. Severe desaturation while attempting one-lung ventilation for congenital cystic adenomatoid malformation with respiratory distress syndrome in neonate -A case report-. Korean J Anesthesiol 2013; 65:80-4. [PMID: 23904945 PMCID: PMC3726853 DOI: 10.4097/kjae.2013.65.1.80] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Revised: 09/04/2012] [Accepted: 09/05/2012] [Indexed: 11/25/2022] Open
Abstract
There are many methods for achieving one-lung ventilation (OLV) during thoracic surgery in neonates and the accuracy of OLV may affect postoperative outcome. The authors have performed OLV using a 5 Fr Arndt endobronchial blocker (AEB, Cook Inc., Bloomington, IN, USA) on a neonate diagnosed with congenital cystic adenomatoid malformation and respiratory distress syndrome (RDS) associated with marked mediastinal shift. In spite of sufficient preoxygenation, sudden and severe fall in oxygen saturation had occurred. Since neonates with RDS may develop sudden and severe desaturation, rapid intubation with anticipation of potential difficulty is necessary as well as sufficient preoxygenation.
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Affiliation(s)
- Ji-Hye Seok
- Department of Anesthesiology and Pain Medicine, Daegu Fatima Hospital, Daegu, Korea
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Sutton CJ, Naguib A, Puri S, Sprenker CJ, Camporesi EM. One-lung ventilation in infants and small children: blood gas values. J Anesth 2012; 26:670-4. [DOI: 10.1007/s00540-012-1413-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Accepted: 04/25/2012] [Indexed: 11/25/2022]
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Stephenson LL, Seefelder C. Routine Extraluminal Use of the 5F Arndt Endobronchial Blocker for One-Lung Ventilation in Children up to 24 Months of Age. J Cardiothorac Vasc Anesth 2011; 25:683-6. [DOI: 10.1053/j.jvca.2010.04.020] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2010] [Indexed: 11/11/2022]
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Muralidhar V, Malik N. One Lung Ventilation Using Bronchial Blocker Through Endotracheal Tube in a Child. Apollo Medicine 2011. [DOI: 10.1016/s0976-0016(11)60065-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Ruetzler K, Grubhofer G, Schmid W, Papp D, Nabecker S, Hutschala D, Lang G, Hager H. Randomized clinical trial comparing double-lumen tube and EZ-Blocker ® for single-lung ventilation. Br J Anaesth 2011; 106:896-902. [DOI: 10.1093/bja/aer086] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Disma N, Mameli L, Pini-Prato A, Montobbio G. One lung ventilation with Arndt pediatric bronchial blocker for thoracoscopic surgery in children: a unicentric experience. Paediatr Anaesth 2011; 21:465-7. [PMID: 21371170 DOI: 10.1111/j.1460-9592.2011.03510.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Raviraj R, Nandhakumar A, Korula G, James JN. A cost-effective alternative to wire-guided endobronchial blocker for lung isolation in children. Paediatr Anaesth 2009; 19:1249-50. [PMID: 20017873 DOI: 10.1111/j.1460-9592.2009.03189.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Li P, Liang W, Gu H. One-lung ventilation using Proseal™ laryngeal mask airway and Arndt endobronchial blocker in paediatric scoliosis surgery. Br J Anaesth 2009; 103:902-3. [DOI: 10.1093/bja/aep325] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Ho AMH, Ng SK, Tsang KHS, Au SW, Ng CSH, Critchle LAH, Karmakar MK. A Technique that may Improve the Reliability of Endobronchial Blocker Positioning during Adult One-lung Anaesthesia. Anaesth Intensive Care 2009; 37:1012-6. [DOI: 10.1177/0310057x0903700614] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
We describe a novel technique, previously applied to small children, for adult one-lung anaesthesia in which a single-lumen endotracheal tube is used with an endobronchial balloon blocker. The main aims of the technique are to reduce the likelihood of cephalad displacement of the balloon into the trachea and to facilitate directional placement of the endobronchial balloon. We present five illustrative cases of one-lung anaesthesia in patients of adult size, in which the endotracheal tube-endobronchial balloon technique was considered preferable to the use of a double-lumen tube technique. The situations included difficult intubation, need for postoperative ventilation, a tortuous trachea and an unexpected need to perform one-lung anaesthesia. The technique involved deliberate placement of the endotracheal tube tip near the carina to block cephalad dislodgement of the blocker. The chance of the balloon blocking the endotracheal tube tip could be further reduced by having the intraluminal endobronchial balloon blocker emerge through the Murphy eye.
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Affiliation(s)
- A. M. H. Ho
- Departments of Anaesthesia and Intensive Care and Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR
- Professor, Department of Anaesthesia and Intensive Care
| | - S. K. Ng
- Departments of Anaesthesia and Intensive Care and Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR
- Consultant, Department of Anaesthesia and Intensive Care
| | - K. H. S. Tsang
- Departments of Anaesthesia and Intensive Care and Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR
- Associate Consultant, Department of Anaesthesia and Intensive Care
| | - S. W. Au
- Departments of Anaesthesia and Intensive Care and Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR
- Medical Officer, Department of Anaesthesia and Intensive Care
| | - C. S. H. Ng
- Departments of Anaesthesia and Intensive Care and Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR
- Resident Specialist, Department of Surgery
| | - L. A. H. Critchle
- Departments of Anaesthesia and Intensive Care and Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR
- Professor, Department of Anaesthesia and Intensive Care
| | - M. K. Karmakar
- Departments of Anaesthesia and Intensive Care and Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR
- Associate Professor, Department of Anaesthesia and Intensive Care
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Ho AH, Karmakar M, Critchley L, Ng S, Wat CY. Placing the tip of the endotracheal tube at the carina and passing the endobronchial blocker through the Murphy eye may reduce the risk of blocker retrograde dislodgement during one-lung anaesthesia in small children †. Br J Anaesth 2008; 101:690-3. [DOI: 10.1093/bja/aen264] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Lee DK, Kim H, Han SJ, Kim NY. One-lung ventilation in a pediatric patient using a wire-guided endobronchial blocker for video-assisted thoracoscopic surgery - A case report -. Korean J Anesthesiol 2008. [DOI: 10.4097/kjae.2008.55.4.516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Dong-Kyu Lee
- Department Anesthesiology and Pain Medicine, College of Medicine, Korea University, Seoul, Korea
| | - Heezoo Kim
- Department Anesthesiology and Pain Medicine, College of Medicine, Korea University, Seoul, Korea
| | - Sung-jin Han
- Department Anesthesiology and Pain Medicine, College of Medicine, Korea University, Seoul, Korea
| | - Nam-yeop Kim
- Department Anesthesiology and Pain Medicine, College of Medicine, Korea University, Seoul, Korea
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Abstract
BACKGROUND Pediatric scoliosis surgery may require single lung ventilation for surgical access. Current methods of lung isolation are inadequate for some or all of these children. The Arndt endobronchial blocker (EBB) has been described for use in pediatric thoracic surgery to enable single lung ventilation (SLV). There are few data on its use in pediatric spinal deformity surgery. We report the successful use of the Arndt EBB in a series of these patients. METHODS Any patient undergoing surgical correction of scoliosis involving a lateral thoracotomy for an anterior approach was managed with an Arndt EBB (5, 7 and 9 Fr gauge) to facilitate SLV. All cases were undertaken by a pediatric anesthetist trained in pediatric bronchoscopy; a 2.2 or 2.8 mm pediatric fiberoptic scope was used for placement and positional confirmation. RESULTS Patients' ages and weights ranged from 18 months to 18 years, and from 9.4 to 71 kg. All had idiopathic or congenital scoliosis; one underwent a vertical expansion prosthetic titanium rib (VEPTR) procedure. In all 20 patients, placement was easily and quickly achieved with no incorrect placements. There was one displacement after inflation, quickly corrected. Right upper lobe deflation proved difficult in one patient with high take-off of the right upper lobe bronchus. The surgical field was excellent in all cases. CONCLUSIONS In our case series, Arndt EBB provided a safe and highly effective means of single lung isolation for children undergoing pediatric scoliosis surgery.
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Affiliation(s)
- G T Bird
- Department of Anaesthetics, St Thomas' Hospital, London, UK
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Abstract
PURPOSE Attaining lung isolation in the infant undergoing thoracic anesthesia can be challenging for the anesthesiologist. We describe a novel approach to performing lung isolation in an infant undergoing thoracotomy for lobectomy using an Arndt pediatric endobronchial blocker via an extraluminal technique. CLINICAL FEATURES Lung isolation in an infant was achieved through the use of an Arndt pediatric endobronchial blocker placed externally to an endotracheal tube. The blocker's placement was facilitated through the use of a pediatric fibreoptic brochoscope placed through the guidewire of the extraluminally placed bronchial blocker. CONCLUSION This novel technique may provide an easier and more reliable method of attaining single lung ventilation in infants and small children.
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Affiliation(s)
- John L Bastien
- Department of Anesthesiology, Naval Medical Center Portsmouth, 620 John Paul Jones Circle, Portsmouth, VA 23708-2197, USA.
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