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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] [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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Liu Z, Zhao L, Zhu Y, Bao L, Jia QQ, Yang XC, Liang SJ. The efficacy and adverse effects of the Uniblocker and left-side double-lumen tube for one-lung ventilation under the guidance of chest CT. Exp Ther Med 2020; 19:2751-2756. [PMID: 32256757 DOI: 10.3892/etm.2020.8492] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Accepted: 01/22/2020] [Indexed: 11/06/2022] Open
Abstract
One-lung ventilation (OLV) is essential in numerous clinical procedures, in which the left-sided double-lumen tube (LDLT) is the most commonly used device. The application of bronchial blockers, including the Uniblocker or Arndt blocker, has increased in OLV. The present study aimed to compare the efficacy and adverse effects of the Uniblocker and LDLT for OLV under the guidance of chest CT. A total of 60 adult patients undergoing elective left-side thoracic surgery requiring OLV were included in the study. The patients were randomly assigned to the Uniblocker group (U group, n=30) or the LDLT group (D group, n=30). The time for initial tube placement, the number of optimal positions of the tube upon blind insertion, the number of attempts to adjust the tube to the optimal position, incidence of airway device displacement, injury to the bronchi and carina, the duration until lung collapse and the occurrence of sore throat and hoarseness over 24 h following surgery were recorded. The time for successful placement of the LDLT was 83.9±19.4 sec and that for the Uniblocker was 84.3±17.1 sec (P>0.05). The degree of lung collapse 1 min following opening of the pleura was greater in the D group than that in the U group (P<0.01) and the time required for the lung to completely collapse was shorter in the D group (3.3±0.5 min) than that in the U group (8.4±1.2 min; P<0.01). On the contrary, the incidence of injury to the bronchi and carina was lower in the U group (2/30 cases) than in the D group (10/30 cases; P=0.02); the incidence of sore throat was also lower in the U group (2/30 cases) compared with that in the D group (9/30 cases). The mean arterial pressure of patients immediately following intubation was lower in the U group (122.0±13.4 mmHg) than that in the D group (129.2±12.1 mmHg; P<0.05). The results of the present study indicated that the extraluminal use of the Uniblocker under guidance of chest CT is an efficient method with few adverse effects in left-side thoracic surgery. The study was registered at ClinicalTrials.gov on 16th December 2017 (no. NCT03392922).
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Affiliation(s)
- Zhuo Liu
- Department of Anesthesiology, The First Hospital of Qinhuangdao, Qinhuangdao, Hebei 066000, P.R. China
| | - Li Zhao
- Department of Thoracic Surgery, The First Hospital of Qinhuangdao, Qinhuangdao, Hebei 066000, P.R. China
| | - Yan Zhu
- Department of Anesthesiology, The First Hospital of Qinhuangdao, Qinhuangdao, Hebei 066000, P.R. China
| | - Lina Bao
- Department of Anesthesiology, The First Hospital of Qinhuangdao, Qinhuangdao, Hebei 066000, P.R. China
| | - Qian-Qian Jia
- Department of Anesthesiology, The First Hospital of Qinhuangdao, Qinhuangdao, Hebei 066000, P.R. China
| | - Xiao-Chun Yang
- Department of Anesthesiology, The First Hospital of Qinhuangdao, Qinhuangdao, Hebei 066000, P.R. China
| | - Shu-Juan Liang
- Department of Anesthesiology, The First Hospital of Qinhuangdao, Qinhuangdao, Hebei 066000, P.R. China
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Liu Z, Zhao L, He W, Zhu Y, Bao L, Jia Q, Yang X, Liang S. A novel method of Uniblocker placement: extraluminal technique supported by trachea length measurement: A CONSORT-compliant article. Medicine (Baltimore) 2019; 98:e15116. [PMID: 30946382 PMCID: PMC6456150 DOI: 10.1097/md.0000000000015116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The use of bronchial blockers has been increased for one-lung ventilation; however, the placement of bronchial blockers is time consuming. The objective of this study was to compare the novel extraluminal technique of Uniblocker placement supported by trachea length measurement on computerized tomography images with conventional intraluminal Uniblocker placement method. METHODS Seventy adult patients undergoing left side thoracic surgery were included in the study. All the patients were randomly assigned to one of two groups: conventional intraluminal intubation group (CV-IN group, n = 35) or extraluminal CT guided group (CT-EX group, n = 35). The primary endpoints were the optimal positions of Uniblocker and the injuries of bronchi and carina. The secondary outcomes included the time of Uniblocker placement, the adequacy of lung collapse, the incidences of Uniblocker displacement, sore throat, and hoarseness postoperative. RESULTS In the CV-IN group, 19 of 35 Uniblockers went to the left main-stem bronchus on the initial blind insertion and 15 of 35 Uniblockers were considered as in optimal depth, whereas in the CT-EX group, 32 of 35 Uniblockers went to the left main-stem bronchus on the initial blind insertion and 31 of 35 Uniblockers were considered as in optimal depth (P < .01). The incidence of bronchi and carina injuries was obviously lower in the CT-EX group (occurred in 1 of 35 cases) than that in the CV-IN group (occurred in 8 of 35 cases) (P < .05). The time of Uniblocker placement took 145.4 s in the CV-IN group and 85.4 s in the CT-EX group (P < .01). The malpositions of Uniblocker, the degree of pulmonary collapse and the adverse events postoperative such as sore throat and hoarseness were not significantly different between the two groups (P > .05). CONCLUSION The novel extraluminal technique of Uniblocker placement supported by trachea length measurement on computerized tomography images was proved to be more rapid, more accurate and less complications than conventional intraluminal Uniblocker placement method.
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Affiliation(s)
- Zhuo Liu
- Department of Anesthesiology, The First Hospital of Qinhuangdao, Qinhuangdao
| | - Li Zhao
- Department of Thoracic Surgery, The First Hospital of Qinhuangdao, Qinhuangdao, Hebei, China
| | - Wensheng He
- Department of Anesthesiology, The First Hospital of Qinhuangdao, Qinhuangdao
| | - Yan Zhu
- Department of Anesthesiology, The First Hospital of Qinhuangdao, Qinhuangdao
| | - Lina Bao
- Department of Anesthesiology, The First Hospital of Qinhuangdao, Qinhuangdao
| | - Qianqian Jia
- Department of Anesthesiology, The First Hospital of Qinhuangdao, Qinhuangdao
| | - Xiaochun Yang
- Department of Anesthesiology, The First Hospital of Qinhuangdao, Qinhuangdao
| | - Shujuan Liang
- Department of Anesthesiology, The First Hospital of Qinhuangdao, Qinhuangdao
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Cerfolio RJ, Smood B, Ghanim A, Townsley MM, Downing M. Decreasing Time to Place and Teach Double-Lumen Endotracheal Intubation: Engaging Anesthesia in Lean. Ann Thorac Surg 2018; 106:1512-1518. [PMID: 30048631 DOI: 10.1016/j.athoracsur.2018.06.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 06/01/2018] [Accepted: 06/07/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND This report documents our process to standardize and decrease the time to place and teach double-lumen endotracheal tube (DLETT) intubation. METHODS A prospective database of patients who underwent lobectomy or segmentectomy by 1 surgeon was reviewed. A systematic approach was instituted starting in 2009. A monitor in the room displayed the bronchoscopic view as anesthesia residents were taught how to drive a bronchoscope. The bronchial side was placed above the carina, a bronchoscope went into the desired side, and the double-lumen tube slid over it. A head towel protected the ears, face, and hair, and the DLETT was anchored so that rebronching after turning was eliminated. All other nonvalued steps were eliminated. RESULTS There were 2,940 patients. Pulmonary lobectomy was performed in 2,421 patients and segmentectomy in 566. Patients were divided into nine cohorts of 350 consecutive patients, except for the last cohort. Median time for DLETT placement decreased from 13 minutes from January 1997 to February 2001 to a median 45 seconds from June 2016 to May 2017 (p < 0.001). Anesthesia residents, present for 76% of the operations, were able to place the tube independently 80% of the time. There were no airway perforations. CONCLUSIONS DLETT placement can be standardized and taught efficiently. Factors that may lead to this are eliminating nonvalued steps (process of lean), engaging anesthesiologists and surgeons to teach team standardization, improved tracheal-bronchial anatomy and bronchoscopy skills in residents, and displaying the intubation and bronchoscopy on a monitor.
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Affiliation(s)
- Robert J Cerfolio
- Division of Thoracic Surgery, Department of Surgery, New York University, New York, New York.
| | - Benjamin Smood
- Department of Surgery, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
| | - Asem Ghanim
- Division of Cardiothoracic Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Matthew M Townsley
- Division of Cardiothoracic Anesthesia, Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Michelle Downing
- Division of Cardiothoracic Anesthesia, Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, Alabama
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Liu Z, He W, Jia Q, Yang X, Liang S, Wang X. A comparison of extraluminal and intraluminal use of the Uniblocker in left thoracic surgery: A CONSORT-compliant article. Medicine (Baltimore) 2017; 96:e6966. [PMID: 28538393 PMCID: PMC5457873 DOI: 10.1097/md.0000000000006966] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The aim of this study was to assess the feasibility and safety issues concerning extraluminal use of the Uniblocker for one-lung ventilation (OLV) in the left thoracic surgery. METHODS Forty patients undergoing elective left thoracic surgery were included in this study, and all patients were randomly allocated to extraluminal use of Uniblocker group (E group, n = 20) or intraluminal use of Uniblocker group (I group, n = 20). Time for intubation, time for verification of the correct position of Uniblocker, incidence of Uniblocker displacement, index of pulmonary collapse, mean arterial pressure, heart rate, peak airway pressure, oxygen saturation in two-lung ventilation, and 30 minutes after OLV, bronchial damage after OLV, sore throat, and hoarseness postoperative were recorded. RESULTS The time for positioning Uniblocker was 112.6 ± 31.2 seconds in intraluminal use group, whereas the time for positioning Uniblocker was significantly shorter in extraluminal use group (63.4 ± 15.8 seconds). The incidence of main bronchial injury, the time of intubation, the incidence of Uniblocker malposition after initial placement, the time of OLV, the degree of pulmonary collapse, mean arterial pressure, heart rate, peak airway pressure, oxygen saturation in two-lung ventilation, and 30 minutes after OLV, the incidence of sore throat and hoarseness postoperative have no statistical significance (P > .05). CONCLUSION Extraluminal use of the Uniblocker was proved to be a more rapid and more accurate method than conventional intraluminal use of the Uniblocker for OLV in left thoracic surgery.
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Affiliation(s)
- Zhuo Liu
- Department of Anesthesiology, The Third Hospital of Hebei Medical University, Shijiazhuang
| | - WenSheng He
- Department of Anesthesiology, The First Hospital of Qinhuangdao, Qinhuangdao, Hebei, China
| | - QianQian Jia
- Department of Anesthesiology, The First Hospital of Qinhuangdao, Qinhuangdao, Hebei, China
| | - XiaoChun Yang
- Department of Anesthesiology, The First Hospital of Qinhuangdao, Qinhuangdao, Hebei, China
| | - ShuJuan Liang
- Department of Anesthesiology, The First Hospital of Qinhuangdao, Qinhuangdao, Hebei, China
| | - XiuLi Wang
- Department of Anesthesiology, The Third Hospital of Hebei Medical University, Shijiazhuang
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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] [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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Abstract
One-lung ventilation is used during a variety of cardiac, thoracic, and major vascular procedures. Endobronchial tubes, bronchial blockers, and occasionally, single-lumen tubes are used to isolate the lungs. Patients with difficult airways and pediatric patients provide special challenges for lung isolation. Finally, intraoperative hypoxia and hypercarbia in patients with intrinsic lung disease frequently complicate one-lung anesthesia. The concepts and controversies in lung isolation techniques are discussed.
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Affiliation(s)
- Edwin Mirzabeigi
- Martin Luther King, Jr/Charles R. Drew University Medical Center, Department of Anesthesiology, Los Angeles, CA 90069, USA
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Abstract
Over the past few decades, major surgical procedures involving the thorax have become commonplace at most larger medical facilities. Advances in perioperative care have allowed surgeons to perform increasingly complex procedures. These procedures are being performed on more seriously ill patients who are at increased risk for significant complications. Recent advances should help the anesthesiologist avoid some of the pitfalls in managing these complex patients. Preoperative assessment aids in the identification of patients at highest risk for intraoperative and postoperative events. Particular attention is given to myasthenia gravis, as thymectomy is among the most common surgical procedures that are performed in these patients. Aggressive pain control techniques, including neuraxial opioids and patient-controlled analgesia, where appropriate, not only improve patient comfort but can improve postoperative pulmonary function. Advances in techniques for providing one-lung ventilation allow the anesthesiologist more options to individualize management for each clinical scenario. Careful fluid management may help to minimize the risk of postoperative pulmonary complications. A basic understanding of video-assisted thoracic surgery should help the anesthesiologist provide optimal surgical conditions and perioperative care. Recent advances demand a greater role for the anesthesiologist if the best outcomes are to be achieved in patients undergoing thoracic procedures.
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Heir JS, Sekhon AK, Thakar DR, Jackson TA, Lasala JD, Purugganan RV. External Tracheal Manipulation Maneuver (ETMM) to Facilitate Endobronchial Blocker Placement. J Cardiothorac Vasc Anesth 2016; 30:1061-3. [DOI: 10.1053/j.jvca.2015.11.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Indexed: 11/11/2022]
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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] [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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Li Q, Li P, Xu J, Gu H, Ma Q, Pang L, Liang W. A novel combination of the Arndt endobronchial blocker and the laryngeal mask airway ProSeal™ provides one-lung ventilation for thoracic surgery. Exp Ther Med 2014; 8:1628-1632. [PMID: 25289071 PMCID: PMC4186338 DOI: 10.3892/etm.2014.1966] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 06/27/2014] [Indexed: 01/01/2023] Open
Abstract
In this study, the feasibility and performance of the combination of the Arndt endobronchial blocker and the laryngeal mask airway (LMA) ProSeal™ in airway establishment, ventilation, oxygenation and lung isolation was evaluated. Fifty-five patients undergoing general anesthesia for elective thoracic surgeries were randomly allocated to group Arndt (n=26) or group double-lumen tube (DLT; n=29). Data concerning post-operative airway morbidity, ease of insertion, hemodynamics, lung collapse, ventilators, oxygenation and ventilation were collected for analysis. Compared with group DLT, group Arndt showed a significantly attenuated hemodynamic response to intubation (blood pressure, 149±31 vs. 115±16 mmHg; heart rate, 86±15 vs. 68±15 bpm), less severe injuries to the bronchus (injury score, 1.4±0.2 vs. 0.4±0.1) and vocal cords (injury score, 1.3±0.2 vs. 0.6±0.1), and lower incidences of post-operative sore throat and hoarseness. Furthermore, the novel combination of the Arndt and the LMA ProSeal showed similar ease of airway establishment, comparable ventilation and oxygenation performance, and an analogous lung isolation effect to DLT. The novel combined use of the Arndt endobronchial blocker and the LMA ProSeal can serve as a promising alternative for thoracic procedures requiring one-lung ventilation. The less traumatic properties and equally ideal lung isolation are likely to promote its use in rapidly spreading minimally invasive thoracic surgeries.
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Affiliation(s)
- Qiong Li
- Department of Anesthesiology, Huashan Hospital, Fudan University, Shanghai 200042, P.R. China
| | - Peiying Li
- Department of Anesthesiology, Huashan Hospital, Fudan University, Shanghai 200042, P.R. China
| | - Jianghui Xu
- Department of Anesthesiology, Huashan Hospital, Fudan University, Shanghai 200042, P.R. China
| | - Huahua Gu
- Department of Anesthesiology, Huashan Hospital, Fudan University, Shanghai 200042, P.R. China
| | - Qinyun Ma
- Department of Thoracic Surgery, Huashan Hospital, Fudan University, Shanghai 200042, P.R. China
| | - Liewen Pang
- Department of Thoracic Surgery, Huashan Hospital, Fudan University, Shanghai 200042, P.R. China
| | - Weimin Liang
- Department of Anesthesiology, Huashan Hospital, Fudan University, Shanghai 200042, P.R. China
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Pulmonary Shunt Is Independent of Decrease in Cardiac Output during Unsupported Spontaneous Breathing in the Pig. Anesthesiology 2013; 118:914-23. [DOI: 10.1097/aln.0b013e318283c81f] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Abstract
Background:
During mechanical ventilation (MV), pulmonary shunt is cardiac output (CO) dependent; however, whether this relationship is valid during unsupported spontaneous breathing (SB) is unknown. The CO dependency of the calculated venous admixture was investigated, with both minor and major shunt, during unsupported SB, MV, and SB with continuous positive airway pressure (CPAP).
Methods:
In seven anesthetized supine piglets breathing 100% oxygen, unsupported SB, MV (with tidal volume and respiratory rate corresponding to SB), and 8 cm H2O CPAP (airway pressure corresponding to MV) were applied at random. Venous return and CO were reduced by partial balloon occlusion of the inferior vena cava. Measurements were repeated with the left main bronchus blocked, creating a nonrecruitable pulmonary shunt.
Results:
CO decreased from 4.2 l/min (95% CI, 3.9–4.5) to 2.5 l/min (95% CI, 2.2–2.7) with partially occluded venous return. Irrespective of whether shunt was minor or major, during unsupported SB, venous admixture was independent of CO (slope: minor shunt, 0.5; major shunt, 1.1%·min−1·l−1) and mixed venous oxygen tension. During both MV and CPAP, venous admixture was dependent on CO (slope MV: minor shunt, 1.9; major shunt, 3.5; CPAP: minor shunt, 1.3; major shunt, 2.9%·min−1·l−1) and mixed-venous oxygen tension (coefficient of determination 0.61–0.86 for all regressions).
Conclusions:
In contrast to MV and CPAP, venous admixture was independent of CO during unsupported SB, and was unaffected by mixed-venous oxygen tension, casting doubt on the role of hypoxic pulmonary vasoconstriction in pulmonary blood flow redistribution during unsupported SB.
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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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Thomas T, Dimitrova G, Awad H. Avulsion of a bronchial blocker cuff in the trachea when using a Parker Flex-Tip endotracheal tube. J Cardiothorac Vasc Anesth 2010; 25:391-2. [PMID: 20573519 DOI: 10.1053/j.jvca.2010.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2010] [Indexed: 11/11/2022]
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Bauquier SH, Dusavage S, Driessen B. Anaesthesia and ventilation strategy in a horse undergoing pulmonectomy. EQUINE VET EDUC 2010. [DOI: 10.1111/j.2042-3292.2010.00072.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Affiliation(s)
- J B Brodsky
- Department of Anesthesia, H 3580, Stanford University Medical Center, Stanford, CA 94305, USA.
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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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Neustein SM. The Use of Bronchial Blockers for Providing One-Lung Ventilation. J Cardiothorac Vasc Anesth 2009; 23:860-8. [PMID: 19632864 DOI: 10.1053/j.jvca.2009.05.014] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2009] [Indexed: 11/11/2022]
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Cohen E. Pro: The New Bronchial Blockers Are Preferable to Double-Lumen Tubes for Lung Isolation. J Cardiothorac Vasc Anesth 2008; 22:920-4. [PMID: 19038740 DOI: 10.1053/j.jvca.2008.09.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2008] [Indexed: 02/08/2023]
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20
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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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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21
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Memtsoudis SG, Sadovnikoff N. Successful management of a trauma patient with pulmonary hemorrhage using a wire-guided bronchial blocker. ACTA ACUST UNITED AC 2008; 63:E127-9. [PMID: 17429325 DOI: 10.1097/01.ta.0000195458.68772.1f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Stavros G Memtsoudis
- Department of Anesthesiology, Perioperative and Pain Medicine, Division of Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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22
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Bird GT, Hall M, Nel L, Davies E, Ross O. Effectiveness of Arndt endobronchial blockers in pediatric scoliosis surgery: a case series. Paediatr Anaesth 2007; 17:289-94. [PMID: 17263748 DOI: 10.1111/j.1460-9592.2006.02121.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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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Soto RG, Oleszak SP. Resection of the Arndt Bronchial Blocker During Stapler Resection of the Left Lower Lobe. J Cardiothorac Vasc Anesth 2006; 20:131-2. [PMID: 16458238 DOI: 10.1053/j.jvca.2005.04.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2005] [Indexed: 11/11/2022]
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Abstract
One-lung ventilation (OLV) is usually achieved by the use of a double-lumen tubes (DLTs). With increasing need for use of OLV for video-assisted thoracoscopic procedures, the limitations of traditional DLT's, including difficult insertion and positioning, have become evident. This has led to renewed interest in devising alternative methods of achieving lung separation, such as the Univent tube or Arndt endobronchial blocker. This report describes the technical features and clinical use of a new tip-deflecting endobronchial blocker.
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Affiliation(s)
- Edmond Cohen
- Department of Anesthesiology, Mount Sinai School of Medicine, New York, New York
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Ruiz P, Kovarik G. Lung mechanics and gas exchange in one-lung ventilation following contralateral resection. Can J Anaesth 2005; 52:986-9. [PMID: 16251567 DOI: 10.1007/bf03022063] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To describe the anesthetic management of a patient with previous left lower lobe resection who was submitted to a right upper lobectomy and review the changes in gas exchange and respiratory mechanics which occurred intraoperatively. CLINICAL FEATURES A 69-yr-old male with lung cancer, emphysema and obstructive sleep apnea, presented for a right upper lobectomy. His history was also positive for a left lower lobectomy six years previously. Intraoperative lung isolation was achieved using a 41 F left double-lumen tube (DLT). Monitoring the respiratory mechanics allowed for continuous adjustment of ventilator settings during the various phases of the surgery avoiding the risks of barotrauma and volutrauma. Problems with oxygenation occurred during one-lung ventilation. CONCLUSION This case report shows that a severe level of hypoxemia and hypercarbia associated to lung mechanical property changes can be observed during the OLV phase. Application of continuous positive airway pressure on the non-dependent lung partially corrected blood oxygenation. Lobe isolation techniques should be considered as useful options for intraoperative airway management for these patients.
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Affiliation(s)
- Pedro Ruiz
- Department of Anesthesia, Montreal General Hospital, McGill University Health Centre, 1650, avenue Cedar, Room D10 165.3, Montréal, Québec H3G 1A4, Canada.
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26
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Abstract
This is a report of a case in which an endobronchial blocker was dislodged, leading to severe air trapping and a brief episode of pulseless electrical activity. Bronchial blockade for lung deflation was successfully instituted during emergency repair of a ruptured descending aortic aneurysm. During a period not involving manipulation of aortic cross-clamps, end-tidal CO2 decreased precipitously to zero and airway pressures increased markedly, followed by equalization of intracardiac pressures. Prompt deflation of the endobronchial blocker balloon reversed the problem. We hypothesize that when surgical manipulation dislodged the bronchial blocker into the tracheal position, leading to profound air trapping as successive, stacked tidal volumes were forced distal to the blocker.
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Affiliation(s)
- Warren S Sandberg
- Department of Anesthesia & Critical Care, Massachusetts General Hospital, Boston, Massachusetts
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27
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Motsch J, Wiedemann K, Roggenbach J. Atemwegsmanagement bei der Ein-Lungen-Ventilation. Anaesthesist 2005; 54:601-22; quiz 623-4. [PMID: 15933878 DOI: 10.1007/s00101-005-0866-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The progress in sophisticated and complex operating methods for intrathoracic procedures demands reliable lung separation with the possibility of one-lung ventilation. Patients with thoracic traumas and pulmonary emergencies can confront any anaesthesiologist with the need for lung separating procedures. This review describes the contemporary procedures for lung separation. The special aspects of difficult airway management during one-lung ventilation and the indications for one-lung ventilation are described in detail. The pathophysiological changes during one-lung ventilation and strategies to avoid hypoxemia and to preserve adequate oxygenation are discussed.
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Affiliation(s)
- J Motsch
- Klinik für Anaesthesiologie, Universitätsklinikum Heidelberg.
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28
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Kleinbub MT, Lewis NW, Head CA, Castresana M. Detachment of Arndt endobronchial balloon cuff into right mainstem bronchus. J Cardiothorac Vasc Anesth 2005; 19:273-4. [PMID: 15868546 DOI: 10.1053/j.jvca.2005.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
The progress in lung separation technology has allowed anesthesiologists to become skillful in fiberoptic bronchoscopy techniques and to provide excellent lung exposure in thoracic surgery patients. Given the availability of two technologies--DLTs (right-sided and left-sided) and bronchial blocker technology (TCBU, Arndt, and Cohen--every case that requires lung collapse and OLV should receive the benefit of these devices. Because of its greater margin of safety, a left-sided DLT is the more common device used in lung separation. If any contraindication to placing a left-sided DLT exists, a right-sided DLT is an option for any specific situation (eg, left lung transplantation). For a patient who requires lung separation and presents with the dilemma of a difficult or abnormal airway, bronchial blockers offer more advantages. Regardless of the device used, the optimal position of these devices (DLTs and bronchial blockers) is achieved best with the use of fiberoptic bronchoscopy techniques first in supine and then in lateral decubitus position or whenever repositioning of the device is needed.
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Affiliation(s)
- Javier H Campos
- Department of Anesthesia, University of Iowa Health Care, 200 Hawkins Drive, Iowa City, IA 52242-1079, USA.
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Wald SH, Mahajan A, Kaplan MB, Atkinson JB. Experience with the Arndt paediatric bronchial blocker. Br J Anaesth 2004; 94:92-4. [PMID: 15486004 DOI: 10.1093/bja/aeh292] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Previously reported techniques for single lung ventilation in children have failed to provide consistent, single lung ventilation with relative ease and reliability. We report our experience with the use of a new device, the Arndt 5 French (Fr) paediatric endobronchial blocker, for single lung ventilation in a series of 24 children. We were able to achieve single lung ventilation in 23 of the 24 patients (aged 2-16 yr). Placement required approximately 5-15 min. Attempts at placement were aborted in one patient who was unable to tolerate even short periods of apnoea because of lung pathology. Although it has some limitations, our experience suggests that the paediatric bronchial blocker can be used as a consistent, safe method of single lung ventilation in most young children.
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Affiliation(s)
- S H Wald
- Departments of Anesthesiology and Surgery at the David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA.
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[Lung separation after reintubation with airway exchange catheter in multiple trauma patient with massive haemoptysis]. ACTA ACUST UNITED AC 2004; 23:920-4. [PMID: 15471641 DOI: 10.1016/j.annfar.2004.07.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2003] [Accepted: 07/02/2004] [Indexed: 12/01/2022]
Abstract
A 24-year-old man fell from the third floor. He developed an unilateral pulmonary parenchymal injury and a significant haemoptysis following blunt thoracic trauma. Because of its abundance, it was not possible to obtain adequat oxygenation. To protect controlateral lung from inhalation and to achieve adequat oxygenation, we used double lumen endotracheal tube, lung separation and one lung ventilation. To solve potential airway management difficulties (haemorrhage, trauma, cervical immobilization), we used airway exchange catheter (Cook) to place the double lumen endotracheal tube. Haemoptysis has been controlled by embolization of the right bronchial artery.
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32
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Abstract
One-lung ventilation and isolation can be performed using a double-lumen endotracheal tube or one of several alternative airway devices. We report a case in which sequential lung isolation was performed by placing two Arndt bronchial blockers through a single-lumen endotracheal tube. Traditional double-lumen tubes can be difficult to place and have potential complications that may be avoided by placing two Arndt blockers.
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Affiliation(s)
- William C Culp
- Department of Anesthesiology, The University of Texas Medical Branch at Galveston
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33
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Abstract
Techniques for one-lung ventilation (OLV) can be accomplished in two ways: The first involves the use of a double-lumen endotracheal tube (DLT). The second involves blockade of a mainstem bronchus (bronchial blockers). Bronchial blockade technology is on the rise, and in some specific clinical situations (e.g., management of the difficult airway during OLV or selective lobar blockade) it can offer more as an alternative to achieve OLV in adults. Special emphasis on newer information for the use of Fogarty embolectomy catheter as a bronchial blocker, the torque control blocker Univent, and the wire-guided endobronchial blocker (Arndt blocker) is included. Also this review describes placement, positioning, complications, ventilation modalities, and airflow resistances of all three bronchial blockers. Finally, the bronchial blockers can be used in many cases that require OLV, taking into consideration that bronchial blockers require longer time for placement, assisted suction to expedite lung collapse, and the use of fiberoptic bronchoscopy. The current use of bronchial blockers, supported by scientific evidence, dictates that bronchial blockers should be available in any service that performs lung separation techniques.
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Affiliation(s)
- Javier H Campos
- Department of Anesthesia, University of Iowa Health Care, Iowa City, Iowa
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Abstract
A variety of different endotracheal tubes are available for distinct purposes, though the majority of patients will be well served with the standard single-lumen endotracheal tube. Specialized endotracheal tubes have been developed to aid in specific situations and novel tubes continue to be evaluated as clinicians strive for improved outcomes in various clinical conditions. Ultimately, the choice of an endotracheal tube depends on the purpose it is intended to serve.
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Affiliation(s)
- Anthony W Gray
- Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA 02111, USA.
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Campos JH, Kernstine KH. A comparison of a left-sided Broncho-Cath with the torque control blocker univent and the wire-guided blocker. Anesth Analg 2003; 96:283-9, table of contents. [PMID: 12505967 DOI: 10.1097/00000539-200301000-00056] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
UNLABELLED Lung isolation can be accomplished in two ways: the first, a double-lumen endotracheal tube (DLT) and the second, a bronchial blocker (Univent or Arndt blocker). Previous studies have found that the DLT and the Univent are comparable when providing lung isolation. A new bronchial blocker, the wire-guided endobronchial blocker (Arndt blocker), has been introduced. However, there is no study to report its effectiveness with lung isolation during elective thoracic surgical cases. Therefore, we designed a prospective, randomized trial to compare the effectiveness of lung isolation among the 3 endotracheal tubes: the left-sided DLT Broncho-Cath Group A (n = 16 patients), the torque control blocker Univent Group B (n = 16 patients), and the wire-guided Arndt blocker Group C (n = 32 patients). The following variables were recorded: 1) time to initially position the assigned tube, 2) frequency of malpositions, 3) frequency of use of fiberoptic bronchoscope, 4) overall surgical exposure, and 5) tube acquisition cost. The Arndt blocker took longer to place (3:34 min/s) compared with the other 2 groups: the DLT group (2:08 min/s) or the Univent group (2:38 min/s) (P < 0.0004). There was no statistical difference in tube malpositions among the three groups: two for the DLT group, four for the Univent group, and nine in the Arndt group. Excluding the time for tube placement, the Arndt group also took longer for the lung to collapse (26:02 min/s), compared with the DLT group (17:54 min/s) or Univent group (19:28 min/s) (P < 0.0060). Furthermore, unlike the other two groups, the majority of the Arndt patients required suction to achieve lung collapse. Once lung isolation was achieved, overall surgical exposure was rated excellent for the three groups. Acquisition cost for the DLT group was $1663.20 (21 tubes opened), $2329.00 for the Univent group (17 tubes opened), and $3567.00 for the Arndt group (33 wire-guided blockers opened). This study demonstrates that the Arndt blocker takes longer to position and longer to deflate the isolated lung. For elective thoracic surgical cases, once the lung was isolated, the management seemed to be similar for all three tube groups. IMPLICATIONS We compared the latest design of double-lumen tubes Broncho-Cath, Univent, and Arndt blockers during lung isolation. Our results show that the Arndt blocker takes longer to position and longer to deflate the isolated lung. Once the lung was isolated, the management seemed to be similar for all three devices.
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Affiliation(s)
- Javier H Campos
- Department of Anesthesia, University of Iowa Health Care, Iowa City 52242, USA.
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36
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Campos JH, Kernstine KH. A Comparison of a Left-Sided Broncho-Cath® with the Torque Control Blocker Univent and the Wire-Guided Blocker. Anesth Analg 2003. [DOI: 10.1213/00000539-200301000-00056] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Ender J, Bury AM, Raumanns J, Schlünken S, Kiefer H, Bellinghausen W, Petry A. The use of a bronchial blocker compared with a double-lumen tube for single-lung ventilation during minimally invasive direct coronary artery bypass surgery. J Cardiothorac Vasc Anesth 2002; 16:452-5. [PMID: 12154424 DOI: 10.1053/jcan.2002.125144] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To investigate whether a bronchial blocker (BB) placed through a routinely used single-lumen tube (SLT) to achieve 1-lung ventilation is appropriate in patients undergoing a minimally invasive direct coronary artery bypass (MIDCAB) operation. DESIGN Clinical trial. SETTING University hospital. PARTICIPANTS Patients scheduled for elective MIDCAB operation (n = 159). INTERVENTIONS Group A was treated with a left-sided double-lumen tube (DLT) and served as the control group. Group B was intubated with a routinely used SLT in combination with a BB. MEASUREMENTS AND MAIN RESULTS The following data were collected: (1) time required for placement of each tube, (2) ventilation pressures, (3) lung compliance, (4) dislocations of the DLT or BB, (5) effectiveness of lung collapse, and (6) PaO(2) and fraction of inspired oxygen. In 4 patients (4%) of group B, the BB could not be placed within an acceptable time so that 155 patients (50 patients in group A, 105 patients in group B) were statistically analyzed. Statistically significant differences during 1-lung ventilation were found for peak and mean inspiratory pressure (p < 0.001 and p < 0.05), dynamic and static lung compliance (p < 0.05), and dynamic lung compliance change (p < 0.01). No statistical significance was found for intubation time (p > 0.05) and PaO(2) and fraction of inspired oxygen (p > 0.05). Lung collapse was insufficient in 1 patient of group A (2%) and in 2 patients of group B (2%). CONCLUSION To achieve 1-lung ventilation during a MIDCAB procedure, the use of a BB combined with an SLT is an appropriate technique as an alternative to the commonly used DLT.
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Affiliation(s)
- Jörg Ender
- Department of Anesthesia and Intensive Care II, Heart-center, University of Leipzig, Leipzig, Germany.
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Kabon B, Waltl B, Leitgeb J, Kapral S, Zimpfer M. First experience with fiberoptically directed wire-guided endobronchial blockade in severe pulmonary bleeding in an emergency setting. Chest 2001; 120:1399-402. [PMID: 11591587 DOI: 10.1378/chest.120.4.1399] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
We report the first use of a new wire-guided endobronchial blocker in a critical respiratory situation caused by localized pulmonary bleeding. During emergency management, it became increasingly difficult to ventilate a multiple-trauma patient with a conventional single-lumen tube because of massive bleeding through the bronchus of the left lower lobe. Using the Arndt endobronchial blocker set (William Cook Europe A/S; Bjaeverskor, Denmark), we were able to prevent the spread of hemorrhaging and achieved effective ventilation and marked improvement in gas exchange. This new device allows the effective blockade of an isolated lobe under direct bronchoscopy to buy time for further intervention.
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Affiliation(s)
- B Kabon
- Department of Anesthesiology and General Intensive Care, University of Vienna, Austria.
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40
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Abstract
The practice of thoracic anesthesia requires a clear understanding of the techniques of lung separation and the technical skills necessary to apply such techniques. Customarily they are classified as absolute or relative.
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Affiliation(s)
- E Cohen
- Department of Anesthesiology, Mount Sinai School of Medicine, New York, New York, USA
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41
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Abstract
Left-sided double-lumen endotracheal tubes should be the tube of choice for most cases in which lung isolation is required. A right-sided double-lumen endotracheal tube can be used effectively when a contraindication to placing a left-sided double-lumen endotracheal tube exists. The method of choice to select left-sided double-lumen endotracheal tubes is based on chest radiograph or CT scan measurements of the trachea or bronchus. Based on clinical reports, Univents or WEB blockers may be a better choice for patients with difficult airways who require one-lung ventilation or for when a selective lobar blockade is needed. For all selective intubation, the method of choice for proper tube placement and bronchial blockade is fiberoptic bronchoscopy with the patient in a supine position at first or in a lateral decubitus position later, or if a malposition occurs.
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Affiliation(s)
- J H Campos
- Department of Anesthesia, College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
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42
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Kuhlman G, Fischler M. [Initial experience with a wire-guided endobronchial blockade to achieve one-lung ventilation]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 2001; 20:378-81. [PMID: 11392249 DOI: 10.1016/s0750-7658(01)00382-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
We report our initial experience with a wire-guided endobronchial blockade, which is a new method to achieve one-lung ventilation with a conventional endotracheal tube. The strong points of this device are its ease of use and the fast training, the possibility of setting it up after the patient was positioned in lateral decubitus position or in the course of intervention as well as the maintenance of ventilation during insertion. Its weak points are the lack of a paediatric model and the quality of the lung collapse which requires a particular operation to be perfect.
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Affiliation(s)
- G Kuhlman
- Service d'anesthésie, hôpital Foch, 92151 Suresnes, France
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43
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Weiss YG, Deutschman CS. The role of fiberoptic bronchoscopy in airway management of the critically ill patient. Crit Care Clin 2000; 16:445-51, vi. [PMID: 10941583 DOI: 10.1016/s0749-0704(05)70122-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Fiberoptic bronchoscopes (FOB) play a pivotal role in airway management in the operating room and critical care environments. This article examines the role of FOBs in modern airway management based on a review of recent literature and personal experience.
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Affiliation(s)
- Y G Weiss
- Department of Anesthesiology, Hadassah University Hospital, Hebrew University, Hadassah Medical School, Jerusalem, Israel.
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