One lung ventilation strategies for infants and children undergoing video assisted thoracoscopic surgery

Single-Lung Ventilation in Infants for Surgical Repair of Coarctation of The Aorta Without Cardiopulmonary Bypass

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.

Hypoxemia in School-age Children Undergoing One-lung Ventilation: A Retrospective Cohort Study from the Multicenter Perioperative Outcomes Group

BACKGROUND

Risk factors for hypoxemia in school-age children undergoing one-lung ventilation remain poorly understood. The hypothesis was that certain modifiable and nonmodifiable factors may be associated with increased risk of hypoxemia in school-age children undergoing one-lung ventilation and thoracic surgery.

METHODS

The Multicenter Perioperative Outcomes Group database was queried for children 4 to 17 yr of age undergoing one-lung ventilation. Patients undergoing vascular or cardiac procedures were excluded. The original cohort was divided into two cohorts: 4 to 9 and 10 to 17 yr of age inclusive. All records were reviewed electronically for the primary outcome of hypoxemia during one-lung ventilation, which was defined as an oxygen saturation measured by pulse oximetry (Spo2) less than 90% for 3 min or longer continuously, while severe hypoxemia was defined as Spo2 less than 90% for 5 min or longer. Potential modifiable and nonmodifiable risk factors associated with these outcomes were evaluated using separate multivariable least absolute shrinkage and selection operator regression analyses for each cohort. The covariates evaluated included age, extremes of weight, American Society of Anesthesiologists Physical Status of III or higher, duration of one-lung ventilation, preoperative Spo2 less than 98%, approach to one-lung ventilation, right operative side, video-assisted thoracoscopic surgery, lower tidal volume ventilation (defined as tidal volume of 6 ml/kg or less and positive end-expiratory pressure of 4 cm H2O or greater for more than 80% of the duration of one-lung ventilation), and procedure type.

RESULTS

The prevalence of hypoxemia in the 4- to 9-yr-old cohort and the 10- to 17-yr-old cohort was 24 of 228 (10.5% [95% CI, 6.5 to 14.5%]) and 76 of 1,012 (7.5% [95% CI, 5.9 to 9.1%]), respectively. The prevalence of severe hypoxemia in both cohorts was 14 of 228 (6.1% [95% CI, 3.0 to 9.3%]) and 47 of 1,012 (4.6% [95% CI, 3.3 to 5.8%]). Initial Spo2 less than 98% was associated with hypoxemia in the 4- to 9-yr-old cohort (odds ratio, 4.20 [95% CI, 1.61 to 6.29]). Initial Spo2 less than 98% (odds ratio, 2.76 [95% CI, 1.69 to 4.48]), extremes of weight (odds ratio, 2.18 [95% CI, 1.29 to 3.61]), and right-sided cases (odds ratio, 2.33 [95% CI, 1.41 to 3.92]) were associated with an increased risk of hypoxemia in the older cohort. Increasing age (1-yr increment; odds ratio, 0.88 [95% CI, 0.80 to 0.97]) was associated with a decreased risk of hypoxemia.

CONCLUSIONS

An initial room air oxygen saturation of less than 98% was associated with an increased risk of hypoxemia in all children 4 to 17 yr of age. Extremes of weight, right-sided cases, and decreasing age were associated with an increased risk of hypoxemia in children 10 to 17 yr of age.

EDITOR’S PERSPECTIVE

Curious Case of Pediatric One-Lung Ventilation with Two Endotracheal Tubes: A Case Report

ABSTRACT

One-lung ventilation is indicated during thoracic surgery for visualization and exposure of surgical site. It is achieved with bronchial blockers, double-lumen endobronchial tube, single-lumen endotracheal tubes and Univent tube for infants and children. Fibreoptic bronchoscope is required for placing and confirming the correct position of these tubes. We report a perioperative management of safe conduct of one lung ventilation for a 6-year child undergoing left lower lobe lobectomy through C-MAC video laryngoscope guided two single lumen tubes in limited resource settings where paediatric-sized fibreoptic bronchoscope is unavailable.

A combination of supraglottic airway and bronchial blocker for one-lung ventilation in infants undergoing thoracoscopic surgery

Objectives

One-lung ventilation (OLV) for children under the age of two years is difficult. The authors hypothesize that a combination of a supraglottic airway (SGA) device and intraluminal placement of a bronchial blocker (BB) may provide an appropriate choice.

Design

A prospective method-comparison study.

Setting

Second Affiliated Hospital of Xi'an Jiaotong University, China.

Participants

120 patients under the age of two years undergoing thoracoscopic surgery with OLV.

Interventions

Participants were randomly assigned to receive intraluminal placement of BB with SGA (n = 60) or extraluminal placement of BB with endotracheal tube (ETT) (n = 60) for OLV.

Measurements and main results

The primary outcome was the length of postoperative hospitalization stay. The secondary outcomes were the basic parameters of OLV and investigator-defined severe adverse events. The postoperative hospitalization stay was 6 days (interquartile range, IQR 4-9) in SGA plus BB group compared with 9 days (IQR 6-13) in ETT plus BB group (P = 0.034). The placement and positioning duration of SGA plus BB was 64 s (IQR 51-75) compared with 132 s (IQR 117-152) of ETT plus BB (P = 0.001). The values of leukocyte (WBC) and C-reactive protein (CRP) of SGA plus BB group on the first day of post-operation were 9.8 × 10⁹/L (IQR 7.4-14.5) and 15.1 mg/L (IQR 12.5-17.3) compared with 13.6 × 10⁹/L (IQR 10.8-17.1) and 19.6 mg/L (IQR 15.0-23.5) of ETT plus BB group (P = 0.022 and P = 0.014).

Conclusion

There were few if any significant adverse events in the intervention group (SGA plus BB) for OLV in children under the age of two years, and this method seems worthy of clinical application. Meanwhile, the mechanism for this novel technique to shorten the length of postoperative hospitalization stay needs to be further explored.

Review of risk factors, clinical manifestations, rapid diagnosis, and emergency treatment of neonatal perioperative pneumothorax

Perioperative neonatal pneumothorax (NP) is rare but very fatal. Most of the surgeries and treatments in the neonatal period are time-limited or emergent, and there are often some risk factors for pneumothorax before surgery. Physicians, surgeons and anesthesiologists need to identify possible risk factors for pneumothorax before surgery in preterm babies, patients receiving mechanical ventilation and those with underlying lung disease. The clinical presentation of NP is nonspecific, and patients may rapidly develop life-threatening complications if not promptly diagnosed and managed. This review highlights recent progress in the identification of risk factors, clinical manifestations, diagnosis and management of NP during the perioperative period.

Ultrasound-Guided Selective Bronchial Intubation: A Feasibility Study in Pediatric Animal Model

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.

Lung Ultrasound to Assess One Lung Ventilation: A Pediatric Case Series

Objectives: One lung ventilation (OLV) is the preferred ventilation technique for thoracoscopy as it provides a better exposure of the operative field and grants the protection of the healthy lung. Preoperative evaluation of lung exclusion is necessary and different methods are available. In recent years lung ultrasound (US) gained popularity and its use for monitoring the endotracheal tube position is widely reported. The existing evidence on adults addresses lung US as effective, yet only few data are available in children. Therefore, we present our experience with lung US as verification method for pediatric OLV. Methods: All patients undergoing OLV for video-assisted thoracoscopic surgery from January 2019 to May 2021 and for whom lung exclusion was confirmed through lung US were involved. Lung exclusion was considered effective when absence of lung motion and presence of lung pulse were encountered. When lung US did not match these criteria, repositioning of the endobronchial device followed by US verification was performed. When lung US met the exclusion criteria surgery was started and direct thoracoscopic observation was used to verify lung exclusion. Results: A total of 20 patients, accounting for 22 procedures, were involved. Absence of lung motion and presence of lung pulse were assessed in the operative-side lung for all patients. Lung exclusion was confirmed through thoracoscopy. Postoperative lung US proved the reappearance of lung motion in the previously excluded lung. Conclusions: In our center experience lung US resulted to be a safe, effective, and time-saving verification method for OLV. Further studies are needed to define its sensitivity and specificity.

Pediatric lower respiratory tract infection: Considerations for the anesthesiologist

Neonatal and childhood infectious diseases continue to be a global health problem. Acute respiratory tract infections are typically classified as upper respiratory tract infection and lower respiratory tract infections. The most common lower respiratory infections in childhood are pneumonia and bronchiolitis. Vaccination against measles, diphtheria, pertussis, Haemophilus influenzae, pneumococcus, and influenza resulted in a significant reduction in the incidence of acute respiratory tract infection globally. Though the global burden of the disease has decreased, the mortality rates still are higher in developing countries. Patients with severe lower respiratory tract infections and their complications are often evaluated for elective or emergency procedures. In this review article, the authors aim to discuss the etiology, pathogenesis, preoperative evaluation of lower respiratory tract infections, and the anesthesia implications pertinent to the practice of anesthesia.

Anesthesia for thoracic surgery in infants and children

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.

Hypoxemia in Young Children Undergoing One-lung Ventilation: A Retrospective Cohort Study

BACKGROUND

One-lung ventilation in children remains a specialized practice with low case numbers even at tertiary centers, preventing an assessment of best practices. The authors hypothesized that certain case factors may be associated with a higher risk of intraprocedural hypoxemia in children undergoing thoracic surgery and one-lung ventilation.

METHODS

The Multicenter Perioperative Outcomes database and a local quality improvement database were queried for documentation of one-lung ventilation in children 2 months to 3 yr of age inclusive between 2010 and 2020. Patients undergoing vascular or other cardiac procedures were excluded. All records were reviewed electronically for the presence of hypoxemia, oxygen saturation measured by pulse oximetry (Spo2) less than 90% for 3 min or more continuously, and severe hypoxemia, Spo2 less than 90% for 5 min or more continuously during one-lung ventilation. Records were also assessed for hypercarbia, end-tidal CO2 greater than 60 mmHg for 5 min or more or a Paco2 greater than 60 on arterial blood gas. Covariates assessed for association with these outcomes included age, weight, American Society of Anesthesiologists (Schaumburg, Illinois) Physical Status 3 or greater, duration of one-lung ventilation, preoperative Spo2 less than 98%, bronchial blocker versus endobronchial intubation, left operative side, video-assisted thoracoscopic surgery, lower tidal volume ventilation (tidal volume less than or equal to 6 ml/kg plus positive end expiratory pressure greater than or equal to 4 cm H2O for more than 80% of the duration of one-lung ventilation), and type of procedure.

RESULTS

Three hundred six cases from 15 institutions were included for analysis. Hypoxemia and severe hypoxemia occurred in 81 of 306 (26%) patients and 56 of 306 (18%), respectively. Hypercarbia occurred in 153 of 306 (50%). Factors associated with lower risk of hypoxemia in multivariable analysis included left operative side (odds ratio, 0.45 [95% CI, 0.251 to 0.78]) and bronchial blocker use (odds ratio, 0.351 [95% CI, 0.177 to 0.67]). Additionally, use of a bronchial blocker was associated with a reduced risk of severe hypoxemia (odds ratio, 0.290 [95% CI, 0.125 to 0.62]).

CONCLUSIONS

Use of a bronchial blocker was associated with a lower risk of hypoxemia in young children undergoing one-lung ventilation.

EDITOR’S PERSPECTIVE

Independent Lung Ventilation in a Pediatric Patient with a Firearm Injury

Background: Chest trauma is uncommon in pediatric patients, however, it may be a cause of significant morbidity and mortality. The type and extent of the injury may lead to ventilation and perfusion problems, therefore, there may be a need for mechanical ventilation. Conclusions: "Independent lung ventilation" may be an appropriate option in selected cases in which the aim is to protect the healthy lung or ventilation cannot be obtained with known mechanical ventilation methods. Case: We presented a pediatric patient followed up in the intensive care unit because of a firearm injury, in whom left lung expansion could not be obtained despite repeated interventions, and independent lung ventilation resulted in success.

A Comparison Between Selective Lobar Bronchial Blockade and Main Bronchial Blockade in Pediatric Thoracoscopic Surgery: A Retrospective Cohort Study

OBJECTIVE

The primary objective of this study was to assess the effect of selective lobar blockade on the risk of hypoxemia during one-lung ventilation in pediatric patients undergoing thoracoscopic surgery.

DESIGN

This was a retrospective matched case-control cohort study.

SETTING

The study was performed in a teaching hospital.

PARTICIPANTS

A total of 60 pediatric patients who underwent thoracoscopic surgery in the authors' hospital from March 2020 to March 2021 were analyzed.

INTERVENTIONS

The authors examined their electronic medical records and found 30 patients in whom selective lobar blockade was used. These patients then were matched to 30 other patients in whom routine main bronchial blockade was performed in the authors' center based on age, weight, sex, side of surgery, and type of surgery.

MEASUREMENTS AND MAIN RESULTS

The inclusion criteria were four-fold: (1) pediatric patients with scheduled thoracoscopic resection of the middle and lower lobe lesions; (2) no obvious anesthesia or surgical contraindications; (3) American Society of Anesthesiologists class I to II; and (4) age younger than one year old. The exclusion criteria were as follows: (1) pediatric patients whose trachea was intubated with a size less than 3.0 mm; (2) a difficult airway; (3) changes in ventilation patterns during surgery; and (4) severe pneumonia and respiratory and circulatory system dysfunction. The following patient data were collected: (1) general clinical information; (2) mean arterial blood pressure, heart rate, central venous pressure, airway peak pressure (Ppeak), oxygenation index (PaO₂/F_IO₂ ratio), and alveolar-arterial oxygen differential pressure (AaDO2) at different time points; that is, before one-lung ventilation (OLV) (T1), ten minutes after OLV (T2), and ten minutes after the end of OLV (T3); (3) degree of lung collapse ten minutes after OLV; (4) operative duration; and (5) the prevalence of hypoxemia, the number of adjustments required for intraoperative displacement of the bronchial blocker, and pulmonary atelectasis. A total of 135 patients were selected, and 60 pediatric patients (30 in group S and 30 in group R) were included in this study. There were no significant differences in age, sex, weight, general preoperative data, degree of lung collapse, or operative duration (p > 0.05). The perioperative hemodynamics between the two groups were not statistically significant (p > 0.05). The oxygenation index, AaDO2, and Ppeak were not significantly different between the two groups at the T1 time point (p > 0.05). However, the oxygenation index was higher, and AaDO2 and Ppeak were lower in group S than in group R at the T2 and T3 time points (p < 0.05). The incidence of atelectasis, the prevalence of hypoxemia, and the number of adjustments required for intraoperative displacement of the bronchial blocker in group S were lower than those in group R (p < 0.05).

CONCLUSION

Selective lobar bronchial blockade, using a bronchial blocker in pediatric thoracoscopic surgery, may represent an alternative to excluding the main bronchial blockade for patients undergoing middle and lower lobe procedures, which may improve intraoperative oxygenation and reduce postoperative atelectasis.

Extraluminal Placement of a Bronchial Blocker Compared with Carbon Dioxide Artificial Pneumothorax in Infants Undergoing Video-Assisted Thoracoscopic Surgery

Objective: To investigate the safety and effectiveness of extraluminal placement of a bronchial blocker compared with carbon dioxide (CO₂) artificial pneumothorax in infants undergoing video-assisted thoracoscopic surgery (VATS).

Methods: The study involved 33 infants (group A) who underwent one-lung ventilation (OLV) with extraluminal placement of a bronchial blocker and 35 other infants (group B) who underwent CO₂ artificial pneumothorax. Clinical characteristics, the degree of lung collapse, and complications were compared.

Results: The degree of lung collapse in group A was significantly higher than that in group B at T2 and T3. The mean arterial pressure (MAP) of group B was significantly lower than that of group A at 10 min and 30 min after OLV. The partial pressure of carbon dioxide (PaCO₂) of group B was significantly higher than that of group A at 30 min after OLV. The incidence of hypotension in group B was higher than that in group A.

Conclusion: Compared with CO₂ artificial pneumothorax, extraluminal placement of a bronchial blocker is associated with a better degree of lung collapse, fewer episodes of hypotension, and lower PaCO₂ accumulation during OLV in infants undergoing VATS.

Endobronchial Blocker Placement for Lung Isolation in Children: A Simple Head Turn Technique

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.

Bronchial Blocker Entrapment in a 7-Month-Old Infant: A Case Report

We present the case of a 7-month-old infant undergoing thoracotomy and left lower lobe lobectomy who experienced a significant complication related to lung isolation with a bronchial blocker. Despite good isolation and seemingly appropriate positioning, the bronchial blocker became entrapped within the staple line at the bronchial stump. Fortunately, the surgeon was able to free the blocker. Going forward, we recommend clinicians be vigilant in positioning the blocker just distal to the carina in all cases and, further, consider retracting the blocker into the trachea before surgical intervention on the airway to avoid inadvertent entrapment of the device.

Ultrasound guided rhomboid intercostal block: A pilot study to assess its analgesic efficacy in paediatric patients undergoing video-assisted thoracoscopy surgery

Background and Aims

Ultrasound guided rhomboid intercostal plane block (RIB) is a relatively new regional anaesthesia technique that has shown to provide dermatomal coverage from T2-9 on the whole anterior and posterior hemithorax. It has proved effective in providing preemptive analgesia in various surgeries like mastectomy and thoracotomy. The aim of the study was to study the efficacy of RIB in paediatric patients: 7 to 12 years undergoing thoracoscopic surgeries in terms of analgesic requirement, pain scores and adverse effects.

Methods

In this randomised, prospective double-blind study, 40 American Society of Anesthesiologists I/II patients, of the age group 7-12 years scheduled for Video-assisted thoracoscopy (VATS) surgery were recruited. The patients were allocated to one of the two groups: group R: general anaesthesia + RIB (RIB group) and group F: general anaesthesia (FENT group). Perioperative opioid consumption and postoperative pain scores were recorded. Adverse effects like respiratory depression and nausea were also noted.

Results

Patients in group R required less intraoperative fentanyl dose (1.45 ± 0.65 vs 2.90 ± 0.45) (P < 0.05). Postoperative opioid consumption was also less in this group R (2.90 ± 0.91 vs 5.56 ± 1.08) (P < 0.05). Less number of patients experienced nausea (2 vs 6) and respiratory depression (2 vs 7) in group R.

Conclusion

Ultrasound guided RIB reduces perioperative opioid consumption in patients undergoing VATS surgery with lesser postoperative pain scores.

Selective bronchial intubation for one-lung ventilation and independent-lung ventilation in pediatric age: state of the art

Selective bronchial intubation (SBI) to ventilate a single lung (one-lung ventilation, OLV) or to apply separate lung ventilation (independent-lung ventilation, ILV) can be frequently required under general anesthesia in pediatrics, mainly in video assisted thoracoscopy surgery, in the postoperative care of cardio-thoracic surgery, and for the treatment of lung pathologies with unilateral prevalence in intensive care. In children over 6-8 years of age SBI, OLV and ILV can be performed using marketed double-lumen tubes (DLTs). In neonates, infants and younger children the application of ILV is limited due to the lack of DLTs. For children of this age, a specific DLT for ILV was developed (Marraro Paediatric Endobronchial Bilumen Tube®) but is currently available only as a special product. The DLT represents the device of choice for OLV and ILV while the use of bronchial blocker is suggested as an alternative to achieve the SBI and the OLV when suitable DLTs are not available. Different catheters types can be used as bronchial blocker. If SBI is not possible using DLT or bronchial blocker, a conventional single-lumen tube of adequate length can allow SBI in all pediatric ages. Using the bronchial blocker and single lumen tube it is possible to perform OLV but it is impossible to apply ILV. The main complications of SBI and DLT are largely due to limited operator experience. Airway trauma, dislodgment and obstruction of the devices are quite frequent and can lead to severe hypoxia if not recognized and treated early.

[Will ultrasound replace the stethoscope?: a case report on neonatal one-lung ventilation]

BACKGROUND AND OBJECTIVES

One-lung ventilation and selective intubation in neonates can be challenging due to intrinsic physiological specificities and material available. Ultrasound (US) is being increasingly used in many extents of anaesthesiology including confirmation of endotracheal tube position.

CASE REPORT

We present a case report of a neonate proposed for pulmonary lobectomy by thoracoscopy in which lung exclusion was confirmed by ultrasound.

CONCLUSION

US is a rapid, more sensitive and specific method than auscultation to evaluate tracheal intubation and lung exclusion.

Will ultrasound replace the stethoscope?: a case report on neonatal one-lung ventilation

Background and objectives

One-lung ventilation and selective intubation in neonates can be challenging due to intrinsic physiological specificities and material available. Ultrasound (US) is being increasingly used in many extents of anaesthesiology including confirmation of endotracheal tube position.

Case report

We present a case report of a neonate proposed for pulmonary lobectomy by thoracoscopy in which lung exclusion was confirmed by ultrasound.

Conclusion

US is a rapid, more sensitive and specific method than auscultation to evaluate tracheal intubation and lung exclusion.

Airway management of congenital pulmonary airway malformation resection in neonates and infants: A case cohort study

BACKGROUND

Anesthestic management of congenital pulmonary airway malformation has not been well described in the literature. It is not clear whether one-lung ventialtion is indicated during thoracoscopic lobectomy and if so, what is the best technique achieve it.

AIMS

We describe the variables with the two commonly performed surgical techniques, thoracoscopic lobectomy and open thoracotomy, from our institutional database to assess the role of lung isolation and the preferable method of lung isolation technique for congenital pulmonary airway malformation resections.

METHODS

After institutional review board approval, fetal center records were reviewed retrospectively from January 2010 to July 2016 for patients who underwent congenital pulmonary airway malformation resection. The primary goal was to describe the anesthesia induction-airway management techniques with emphasis on one-lung ventilation techniques.

RESULTS

Among the 65 resections, one-lung ventilation was performed in 30 resections (46%) and was primarily achieved by endobronchial intubation in most cases (80%). One-lung ventilation was performed in a greater number of resections with thoracoscopic lobectomy (96%) compared to open thoracotomies.

CONCLUSION

From our institution cohort, one-lung ventilation was more commonly used during thoracoscopic resections and was most commonly achieved with endobronchial intubation. Most patients were induced with inhalational anesthesia (sevoflurane), nondepolarizing neuromuscular blocker, and gentle positive pressure ventilation for intubation.

Successful one-lung ventilation by blocking the right intermediate bronchus in a 7-year-old child: a case report

A 7-year-old child underwent surgical excision of a benign mesothelioma of the pleura near the right lower lung. Although insertion of a wire-reinforced endotracheal tube through the left main bronchus was attempted for one-lung ventilation to secure the surgical field of view, the attempt failed. Therefore, an endotracheal tube was inserted into the trachea, and an Arndt endobronchial blocker (Cook Medical, Bloomington, IN, USA) was placed in the right intermediate bronchus under bronchoscopic guidance to selectively block the right lower and middle lobes. The surgery was performed while ventilating the right upper lobe and left lung, and no specific intraoperative adverse events occurred.

Minimal-invasive thoracic surgery in pediatric patients

During the last two decades, there was a tremendous development of video-assisted thoracoscopic surgery (VATS), especially in the field of video-assisted lung resections. This article describes the actually state of this surgical technique in the treatment of pediatric patients. The problems in practical application are illustrated as well as clinical results, like they are presented in literature.

ERS statement: interventional bronchoscopy in children

Paediatric airway endoscopy is accepted as a diagnostic and therapeutic procedure, with an expanding number of indications and applications in children. The aim of this European Respiratory Society task force was to produce a statement on interventional bronchoscopy in children, describing the evidence available at present and current clinical practice, and identifying areas deserving further investigation. The multidisciplinary task force panel performed a systematic review of the literature, focusing on whole lung lavage, transbronchial and endobronchial biopsy, transbronchial needle aspiration with endobronchial ultrasound, foreign body extraction, balloon dilation and occlusion, laser-assisted procedures, usage of airway stents, microdebriders, cryotherapy, endoscopic intubation, application of drugs and other liquids, and caregiver perspectives. There is a scarcity of published evidence in this field, and in many cases the task force had to resort to the collective clinical experience of the committee to develop this statement. The highlighted gaps in knowledge underline the need for further research and serve as a call to paediatric bronchoscopists to work together in multicentre collaborations, for the benefit of children with airway disorders.

Challenges in Anaesthetic management of a child for thoracoscopic assisted oesophageal replacement

The loss of oesophageal length or obliteration of oesophageal lumen due to stricture acquired by accidental caustic ingestion is more common in children that may require major operative reconstruction. A number of procedures have been developed for anatomic replacement of oesophagus of which thoracoscopic assisted gastric transposition has shown the best outcome in children. This demands an extensive pre-operative evaluation, preparation and anaesthetic management since this is challenging and prolonged procedure done under one lung ventilation (OLV). Though it is a minimally invasive procedure, providing OLV and management of complications associated with it are the anaesthetic challenges among these children. We report anaesthetic management of an 8-year-old boy with oesophageal stricture following corrosive injury posted for thoracoscopic assisted gastric transposition.