A modified endotracheal tube for infants and small children undergoing video-assisted thoracoscopic surgery

Video-assisted thoracoscopic surgery

Video-assisted thoracoscopic surgery is finding an ever-increasing role in the diagnosis and treatment of a wide range of thoracic disorders that previously required sternotomy or open thoracotomy. The potential advantages of video-assisted thoracoscopic surgery include less postoperative pain, fewer operative complications, shortened hospital stay and reduced costs. The following review examines the surgical and anesthetic considerations of video-assisted thoracoscopic surgery, with an emphasis on recently published articles.

Perinatal tuberculosis: implications of failure to isolate the lungs in an infant undergoing thoracotomy

A 3-month-old male infant presented with intermittent low-grade fever from the age of 1 month. On investigation, a non-homogenous opacity was found in the upper lobe of the right lung. A computerized tomographic scan revealed loss of aeration of the right upper lobe and partial collapse of the middle lobe. A provisional diagnosis of congenital cystic adenomatoid malformation of the lung (with episodes of infection) was made. We describe the use of a single lumen tracheal tube (TT) for thoracotomy and lobectomy in this infant. The surgical procedure was complicated by a flood of thick, semisolid caseous material from the TT tube causing hypoxia and inability to ventilate the infant. The problem was managed appropriately in the circumstances. The infant died on the 10th postoperative day after two episodes of pneumothorax and, finally, sepsis, and multiorgan failure. Histopathological examination of the tissues and smears revealed acid-fast bacilli in all fields and confirmed the diagnosis of perinatal tuberculosis. This appears to be the first report of its kind of an anesthetic complication of perinatal tuberculosis. A brief update on this condition and the importance of lung separation in infants undergoing thoracotomy is discussed.

New developments in the management of the paediatric airway: cuffed or uncuffed tracheal tubes, laryngeal mask airway, cuffed oropharyngeal airway, tracheostomy and one-lung ventilation devices

The use of a cuffed endotracheal tube should no longer be limited by the age of the child but by his or her clinical condition (e.g. poor lung compliance). To prevent pharyngeal damage, overinflation of the cuff of the laryngeal mask airway should be avoided by inflating it with the minimum volume required to maintain an effective seal and by monitoring intracuff pressure if nitrous oxide is used. Percutaneous tracheostomy in children is still in the experimental stage. New and older devices to perform one-lung ventilation in children are also described.