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Morito T, Matsumura Y. Novel Non-surgical Strategy of Severe Chest Trauma With Venovenous Extracorporeal Membrane Oxygenation, Angioembolization, and Bronchial Blocker: A Case Report. Cureus 2024; 16:e58359. [PMID: 38756313 PMCID: PMC11096805 DOI: 10.7759/cureus.58359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2024] [Indexed: 05/18/2024] Open
Abstract
Severe chest trauma often requires immediate intervention, typically involving open chest surgery. However, advancements in medical technology offer alternative approaches, such as endovascular therapy and venovenous extracorporeal membrane oxygenation (VV-ECMO). In a recent case, a middle-aged male cyclist was admitted after colliding with a vehicle, presenting in shock with multiple injuries, including cerebral contusion and rib fractures. Despite initial treatments such as chest tubes and blood transfusions, his condition remained unstable, with worsening respiratory failure and hemorrhagic shock. A multidisciplinary team devised a comprehensive treatment plan, utilizing VV-ECMO for oxygenation support, a bronchial blocker to localize the hematoma, and interventional radiology for hemothorax hemostasis. These interventions successfully stabilized the patient without resorting to open chest surgery. Endovascular therapy, alongside bronchial blockers, facilitated adequate hemostasis and hematoma localization, avoiding invasive procedures. VV-ECMO plays a crucial role in maintaining oxygenation during respiratory failure. Strategic anticoagulation with nafamostat mesylate prevented clotting in the ECMO circuit. This case highlights the effectiveness of minimally invasive strategies in managing severe chest trauma, preserving lung function, and improving outcomes. In refractory cases, VV-ECMO acts as a bridge to stabilize respiratory status before definitive treatment, while bronchial blockers localize hematomas, reducing the need for surgery. Interventional radiology offers a less invasive option for achieving hemostasis. Collaboration among medical specialties and innovative technologies is critical to successfully navigating complex chest trauma cases.
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Affiliation(s)
- Tomohiro Morito
- Department of Intensive Care, Chiba Emergency and Psychiatric Medical Center, Chiba, JPN
| | - Yosuke Matsumura
- Department of Intensive Care, Chiba Emergency and Psychiatric Medical Center, Chiba, JPN
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Li Y, Zhang Y, Zhang Y, Meng L, Li C, Li J. Laryngeal mask airway combined with bronchial blocker achieved 1-lung ventilation in a patient with bilateral vocal cord paralysis: A case report. Medicine (Baltimore) 2024; 103:e37409. [PMID: 38457595 PMCID: PMC10919457 DOI: 10.1097/md.0000000000037409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 02/07/2024] [Indexed: 03/10/2024] Open
Abstract
INTRODUCTION One-lung ventilation (OLV) is a commonly used technique to facilitate surgical visualization during thoracic surgical procedures. Double-lumen endotracheal tubes and one-lumen tracheal tube combined with bronchial blocker might lead to intubation-related laryngeal injury. PATIENT CONCERNS In the perioperative period, how to avoid further damage to the vocal cord while achieving OLV during operation is challenging work. DIAGNOSIS She was diagnosed with systemic lupus erythematosus, bilateral vocal cord paralysis, and lung tumor. INTERVENTIONS We used a combination of a laryngeal mask airway with bronchial blocker to avoid further damage to the vocal cord when achieving OLV. OUTCOMES At 1-month follow-up, she had fully recovered without obvious abnormalities. CONCLUSION When OLV was required for patients with bilateral vocal cord paralysis, a combination of a laryngeal mask airway with bronchial blocker was considered a better choice.
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Affiliation(s)
- Yi Li
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, China
| | - Yudong Zhang
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, China
| | - Yu Zhang
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, China
| | - Lei Meng
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, China
| | - Chong Li
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, China
| | - Jianli Li
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, China
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Suzuki H, Fujishiro A, Arai T. Successful One-Lung Ventilation With a Double Bronchial Blocker Technique in a Patient With Bronchial Anomaly and Tracheal Stenosis Caused by Kommerell Diverticulum. J Cardiothorac Vasc Anesth 2023; 37:2607-2610. [PMID: 37798241 DOI: 10.1053/j.jvca.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/29/2023] [Accepted: 09/06/2023] [Indexed: 10/07/2023]
Affiliation(s)
- Hiroaki Suzuki
- Department of Anesthesiology, Dokkyo Medical University Saitama Medical Center, Koshigaya City, Japan.
| | - Asuka Fujishiro
- Department of Anesthesiology, Dokkyo Medical University Saitama Medical Center, Koshigaya City, Japan
| | - Takero Arai
- Department of Anesthesiology, Dokkyo Medical University Saitama Medical Center, Koshigaya City, Japan
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Shum S, Moreno Garijo J, Tomlinson G, Rodrigues J, Greyling G, Shafiepour D, McRae K, Slinger P. A Clinical Comparison of 2 Bronchial Blockers Versus Double-Lumen Tubes for One-Lung Ventilation. J Cardiothorac Vasc Anesth 2023; 37:2577-2583. [PMID: 37684137 DOI: 10.1053/j.jvca.2023.08.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 07/19/2023] [Accepted: 08/09/2023] [Indexed: 09/10/2023]
Abstract
OBJECTIVES To compare the quality of lung collapse, time, and number of attempts required to achieve lung isolation, and incidence of intraoperative malpositioning between the EZ blocker (EZB), Fuji Uniblocker (UB), and the left-sided double lumen tube (DLT). DESIGN Prospective, randomized clinical trial. SETTING Single tertiary-level, university-affiliated hospital. PARTICIPANTS Eighty-nine patients undergoing elective open thoracotomies or video-assisted thoracoscopic surgery. INTERVENTIONS The 89 patients were randomized to receive a DLT, UB, or EZB for one-lung ventilation. MEASUREMENTS AND MAIN RESULTS The quality of lung collapse at the time of pleural opening and 10 and 20 minutes thereafter were assessed by the surgeon using the Lung Collapse Score (LCS; 0 = no lung collapse to 10 = best lung collapse). The time and number of attempts required to achieve lung isolation and the number of repositions required during surgery were measured. Tracheobronchial tree measurements were performed by radiologists from preoperative computed tomography imaging. The surgeon remained blinded to the type of device used. Twenty-nine patients were randomized to the DLT group and 30 patients to each of the EZB and UB groups. The LCSs among the groups at pleural opening and 10 minutes after pleural opening were not significantly different (p = 0.34 and p = 0.08, respectively). However, at 20 minutes after the pleural opening, the LCSs were significantly different among groups (p = 0.02), with median scores being significantly lower for DLT (9 [IQR 8-9]) than for EZB (9 [IQR 9-10]; p = 0.04) and UB (9.5 [IQR 9-10]; p = 0.02). Lung isolation was achieved fastest in the DLT group (p < 0.01). The frequency of difficult placement did not significantly differ among groups, although it occurred most frequently in UB (n = 7; 23.3%). Intraoperative repositioning also occurred most often with the UB (n = 15; 50.0%). The EZB had the greatest number of cases requiring >2 repositions (n = 4, 13.3%). There were no differences between preoperative airway measurements and time to isolation or incidence of intraoperative repositioning among the groups. CONCLUSIONS The LCS was comparable among the 3 devices until 20 minutes after pleural opening, when better scores were obtained in the bronchial blocker groups. Lung isolation was achieved fastest with the DLT. The EZB had the highest incidence of cases requiring >2 intraoperative repositions, mostly occurring in R-sided surgery. For L-sided surgery, the EZB performed equally to the UB. This suggests that using the EZB for R-sided video-assisted thoracoscopic surgery may be suboptimal. Preoperative airway dimensions did not correlate with time to achieve isolation or incidence of intraoperative malpositioning.
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Affiliation(s)
- Serena Shum
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, Canada
| | - Jacobo Moreno Garijo
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, Canada; Department of Anesthesia and Pain Management, Sunnybrook Health Sciences Centre, Toronto, Canada.
| | - George Tomlinson
- Biostatistics Research Unit, Toronto General Hospital, Toronto, Canada
| | - Jonathan Rodrigues
- Department of Medical Imaging, Toronto General Hospital, Toronto, Canada
| | - Gerhard Greyling
- Department of Medical Imaging, Toronto General Hospital, Toronto, Canada
| | | | - Karen McRae
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, Canada
| | - Peter Slinger
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, Canada
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Tang JE, Tybout CE, Csernak LM, Awad H, Benavidez PP, Essandoh MK. Tracheal Bronchus and Successful Right-Sided Isolation With a Bronchial Blocker. Semin Cardiothorac Vasc Anesth 2023; 27:235-238. [PMID: 36625339 DOI: 10.1177/10892532231151461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The presence of a tracheal bronchus, which is often incidentally discovered, complicates endotracheal intubation and lung isolation during thoracic surgery. Prior reports of successful right-sided lung isolation in the presence of tracheal bronchus required utilization of a double lumen tube. Although right-sided lung isolation was required in our case, due to other patient factors, it was determined that a double lumen tube of a suitable size would be unlikely to be placed safely and successfully. We describe the successful use of a Rüsch EZ-Blocker bronchial blocker in obtaining right-sided isolation in a patient with a difficult airway and tracheal bronchus.
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Affiliation(s)
- Jonathan E Tang
- Department of Anesthesiology, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Caroline E Tybout
- Department of Anesthesiology, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Lidia M Csernak
- Department of Anesthesiology, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Hamdy Awad
- Department of Anesthesiology, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Pamela P Benavidez
- Department of Anesthesiology, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Michael K Essandoh
- Department of Anesthesiology, Ohio State University Wexner Medical Center, Columbus, OH, USA
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Li YT, Chiu HC, Hsiao YC, Hsu HH, Chen JS, Cheng YJ. Efficacy of rigid-angle bronchial blockers for uniportal video-assisted thoracoscopic tumor resection. Ann Card Anaesth 2023; 26:303-308. [PMID: 37470529 PMCID: PMC10451124 DOI: 10.4103/aca.aca_132_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 02/21/2023] [Accepted: 02/23/2023] [Indexed: 07/21/2023] Open
Abstract
Background For uniportal video-assisted thoracoscopic surgery (VATS), which is greatly dependent on satisfactory lung collapse without lung compression from another port, few reports have elucidated the intraoperative efficacy of bronchial blockers (BBs). We hypothesized that operation time would be prolonged if BBs required more intraoperative repositioning during surgical manipulation. We compared the operation times of different surgical procedures performed using BBs with double-lumen tubes (DLTs) in uniportal VATS. Materials and Methods Patients who underwent intubated uniportal VATS were enrolled retrospectively from March to May 2019. Data on the patient, anesthetic, and surgical factors were collected. Regression analyses were performed to determine the effect of various factors on operation time. Results 317 patients who underwent uniportal VATS were included. Wedge resection constituted 70.7%, and anatomic resection constituted 29.3% of procedures. BBs were applied for left- and right-side wedge resection (85.6% and 78.7%, respectively) and left- and right-side anatomic resection (74.1% and 56.4%, respectively). The surgical factors significantly affecting operation time were operation procedures (P < .01), number of lymph nodes sampled (P < .001), and size of tumors (P < .01). Conclusions The efficacy of BBs was comparable to that of DLTs for uniportal VATS wedge resection. With significantly less preference for right-side anatomic resection, the efficacy of DLTs was comparable with that of BBs, which were applied in more than half of right-side uniportal anatomic VATS. We conclude that even in uniportal VATSs, rigid-angled BBs demonstrate comparable efficacy with feasible alternatives.
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Affiliation(s)
- Ying-Tzu Li
- Department of Anesthesiology, National Taiwan University Cancer Center, Taipei, Taiwan
| | - Hsin-Chan Chiu
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Yueh-Chen Hsiao
- Department of Anesthesiology, National Taiwan University Cancer Center, Taipei, Taiwan
| | - Hsao-Hsun Hsu
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Jin-Shing Chen
- Department of Surgery, National Taiwan University Cancer Center, Taipei, Taiwan
| | - Ya-Jung Cheng
- Department of Anesthesiology, National Taiwan University Cancer Center, Taipei, Taiwan
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Palaczynski P, Misiolek H, Szarpak L, Smereka J, Pruc M, Rydel M, Czyzewski D, Bialka S. Systematic Review and Meta-Analysis of Efficiency and Safety of Double-Lumen Tube and Bronchial Blocker for One-Lung Ventilation. J Clin Med 2023; 12. [PMID: 36902663 DOI: 10.3390/jcm12051877] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 01/29/2023] [Accepted: 02/24/2023] [Indexed: 03/02/2023] Open
Abstract
One-lung ventilation is also used in some thoracic or cardiac surgery, vascular surgery and oesophageal procedures. We conducted a search of the literature for relevant studies in PubMed, Web of Science, Embase, Scopus and Cochrane Library. The final literature search was performed on 10 December 2022. Primary outcomes included the quality of lung collapse. Secondary outcome measures included: the success of the first intubation attempt, malposition rate, time for device placement, lung collapse and adverse events occurrence. Twenty-five studies with 1636 patients were included. Excellent lung collapse among DLT and BB groups was 72.4% vs. 73.4%, respectively (OR = 1.20; 95%CI: 0.84 to 1.72; p = 0.31). The malposition rate was 25.3% vs. 31.9%, respectively (OR = 0.66; 95%CI: 0.49 to 0.88; p = 0.004). The use of DLT compared to BB was associated with a higher risk of hypoxemia (13.5% vs. 6.0%, respectively; OR = 2.27; 95%CI: 1.14 to 4.49; p = 0.02), hoarseness (25.2% vs. 13.0%; OR = 2.30; 95%CI: 1.39 to 3.82; p = 0.001), sore throat (40.3% vs. 23.3%; OR = 2.30; 95%CI: 1.68 to 3.14; p < 0.001), and bronchus/carina injuries (23.2% vs. 8.4%; OR = 3.45; 95%CI: 1.43 to 8.31; p = 0.006). The studies conducted so far on comparing DLT and BB are ambiguous. In the DLT compared to the BB group, the malposition rate was statistically significantly lower, and time to tube placement and lung collapse was shorter. However, the use of DLT compared to BB can be associated with a higher risk of hypoxemia, hoarseness, sore throat and bronchus/carina injuries. Multicenter randomized trials on larger groups of patients are needed to draw definitive conclusions regarding the superiority of any of these devices.
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Muacevic A, Adler JR, Khan AR. Use of an Endo bronchial Blocker Where a Double-Lumen Tube Failed to Ventilate: A Case Report of a Distorted Tracheobronchial Anatomy. Cureus 2022; 14:e32047. [PMID: 36600864 PMCID: PMC9801890 DOI: 10.7759/cureus.32047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2022] [Indexed: 12/05/2022] Open
Abstract
One-lung ventilation (OLV) during video-assisted thoracoscopic surgery (VATS) can be accomplished through several different techniques, including bronchial advancement of an endotracheal tube (ETT), use of a double-lumen tube (DLT), or placement of an endobronchial blocker. In most cases, a DLT is a mainstay of isolating and ventilating a single lung during cardiothoracic procedures. The reasons to deploy a DLT over other techniques include ease of placement, less chance of malposition, quick placement time, and quality of lung deflation. However, this case report highlights the importance of a bronchial blocker in a patient where a double-lumen tube failed to ventilate the lungs. Briefly, this young female patient had a right thoracic mass associated with ipsilateral lung collapse and moderate pleural effusion. CT-guided biopsy was planned but was deferred by the radiologist, as the patient was unable to lie in a prone position. The case was then referred to the cardiothoracic surgeon who planned a right VATS and biopsy of the lesion. In the operation theater, after induction of anesthesia, the patient could not be ventilated through a DLT, and high peak airway pressures were encountered. Initially, a size 37 left-sided DLT was used, and subsequently, sizes 35, 32, and 28 were also tried, but all these attempts to ventilate the patient remained futile. A bronchoscopy was done, which did not show any abnormality in the airway. The surgery was postponed due to an inability to ventilate the patient with a double-lumen tube. After a repeat CT scan and draining of 9.3 liters of pleural effusion over a week, the patient was again scheduled for the same procedure but with a changed anesthetic plan. This time around, the anesthetic plan was implemented successfully using a bronchial blocker to isolate the right lung. The surgery went ahead, and the patient had an uneventful postoperative period. The anesthetic management of this patient presented a unique set of challenges, which are shared in this case report.
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9
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Wang J, Huang X, Hu W, Cheng X, Zhang B. Point-of-care ultrasound to confirm the position of bronchial blockers in children. J Clin Ultrasound 2022; 50:1391-1398. [PMID: 36054377 PMCID: PMC9804773 DOI: 10.1002/jcu.23305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 05/24/2022] [Accepted: 07/02/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE We described the accuracy of ultrasound in determining the position of bronchial blockers (BBs) in children underwent thoracoscopic surgery. METHODS We enrolled 52 children with ASA grade I-III who received thoracoscopic surgery with placement of BBs. Point-of-care ultrasound was performed according to the BLUE protocol. The ultrasound-guided lung sliding sign and curtain sign were used to assess the position of BBs. The accuracy of ultrasound in evaluating the position of BBs, as well as the accuracy and operating time of sliding sign and curtain sign at each examination point were recorded and compared. RESULTS The accuracy of ultrasound in evaluating the position of BBs was 88% (46/52, 95% CI 0.69-0.97). When using the curtain sign to assess the position of BBs, the accuracy was 90% (94/104, 95% CI 0.78-0.96), which was significantly higher than when using the sliding sign (65% (136/208), 95% CI 0.55-0.74) (p = 0.002). The accuracy of curtain sign at the left mid-axillary line-diaphragm and the right mid-axillary line-diaphragm was respectively 96% (50/52, 95% CI 0.80-0.99) and 84% (44/52, 95% CI 0.65-0.95), which were higher than that of sliding sign at upper blue points and lower blue points. There was no significant difference in the operating time between two ultrasound signs (the curtain sign, 13.4 ± 8.2 s vs. the lung sliding sign, 16.2 ± 10.0 s, p = 0.065). CONCLUSION Point-of-care ultrasound can effectively assess the position of BBs. The accuracy of using the curtain sign at the mid-axillary line-diaphragm is higher than that of using the lung sliding sign at the anterior chest wall.
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Affiliation(s)
- Junxia Wang
- Department of Pediatricsthe First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshang HospitalJinanPeople's Republic of China
| | - Xin Huang
- Department of Biostatistics, School of Public Health, Cheeloo College of MedicineShandong UniversityJinanShandongPeople's Republic of China
| | - Weidong Hu
- Department of AnesthesiologyQilu Children's Hospital of Shandong UniversityJinanPeople's Republic of China
| | - Xianling Cheng
- Department of AnesthesiologyQilu Children's Hospital of Shandong UniversityJinanPeople's Republic of China
| | - Bin Zhang
- Department of AnesthesiologyQilu Children's Hospital of Shandong UniversityJinanPeople's Republic of China
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Gil MG, Rubio-Haro R, Morales-Sarabia J, Perez EB, Petrini G, Guijarro R, De Andrés J. A new strategy in lung/lobe isolation in patients with a lung abscess or a previous lung resection using double lumen tubes combined with bronchial blockers. Ann Card Anaesth 2022; 25:343-345. [PMID: 35799564 PMCID: PMC9387630 DOI: 10.4103/aca.aca_16_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 07/25/2021] [Accepted: 08/08/2021] [Indexed: 11/18/2022] Open
Abstract
The combined use of a double-lumen tube and a bronchial blocker can be very helpful in two different clinical scenarios: (1) in isolating not only the contralateral lung, but also the lobe/s of the same lung in which the infected lobe must be resected, (2) in preventing/treating hypoxemia because of the presence of a contralateral lobectomy. A cardiothoracic anesthesiologist must expertise this technique to avoid complications during surgery.
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Affiliation(s)
- Manuel Granell Gil
- Department of Anesthesia Critical Care and Pain Management, Valencia University General Hospital, Tres Creus Avenue; Department of Surgery, Valencia University Medical School, Blasco Ibáñez Av, Valencia, Spain
| | - Ruben Rubio-Haro
- Department of Anesthesia Critical Care and Pain Management, Valencia University General Hospital, Tres Creus Avenue, Valencia, Spain
| | - Javier Morales-Sarabia
- Department of Anesthesia Critical Care and Pain Management, Valencia University General Hospital, Tres Creus Avenue, Valencia, Spain
| | - Elena Biosca Perez
- Department of Anesthesia Critical Care and Pain Management, Valencia University General Hospital, Tres Creus Avenue, Valencia, Spain
| | - Giulia Petrini
- Department of Anesthesia and Critical Care, Cardinal Massaia Hospital, Asti, Italy
| | - Ricardo Guijarro
- Department of Thoracic Surgery, Valencia University General Hospital, Tres Creus Avenue, Valencia, Spain
| | - Jose De Andrés
- Department of Anesthesia Critical Care and Pain Management, Valencia University General Hospital, Tres Creus Avenue; Department of Surgery, Valencia University Medical School, Blasco Ibáñez Av, Valencia, Spain
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Kaplan HJ, Lee RE, Coakley BA. Comparison of Endobronchial Intubation Versus Bronchial Blockade for Elective Pulmonary Lobectomy of Congenital Lung Anomalies in Small Children. J Laparoendosc Adv Surg Tech A 2022; 32:800-804. [PMID: 35394363 PMCID: PMC10402695 DOI: 10.1089/lap.2021.0741] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Purpose: Resection of many congenital lung lesions is commonly performed under single-lung ventilation, which helps collapse the lung being manipulated and enables a thoracoscopic approach in most cases. We set out to determine whether lung isolation achieved by either main stem intubation or usage of a bronchial blocker was associated with superior clinical outcomes. Materials and Methods: A retrospective review of all patients aged <2 years undergoing elective pulmonary lobectomy for congenital lung malformations at a tertiary-care pediatric hospital from 2011 through 2020 was performed. Demographic data, diagnosis type, type of lung isolation method employed, and perioperative outcomes were recorded. Continuous variables were analyzed with Student's t-tests, whereas categorical variables were analyzed with Fisher's exact tests and chi-square tests. Results: Thirty-two patients were analyzed-17 were managed with a bronchial blocker while 15 underwent main stem intubation. The most common diagnoses were congenital pulmonary airway malformations (53.1%) and intralobar bronchopulmonary sequestrations (34.4%). Patients managed with main stem intubation were slightly younger (P = .06) than those for which a bronchial blocker was used. Thirty-one (96.9%) resections were initiated thoracoscopically. Main stem intubation was associated with shorter operative times (P = .01), shorter anesthetic times (P = .02), and less blood loss (P = .04). No differences in length of stay (P = .64), conversation to thoracotomy (P = .35), intraoperative complications (P = .23), or postoperative complications (P = .49) were observed. Conclusion: Lung isolation through main stem intubation, when compared with bronchial blockers, is associated with shorter operative time, shorter anesthetic exposure, and diminished blood loss in pediatric patients undergoing lobectomy for congenital lung anomalies.
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Affiliation(s)
- Harrison J Kaplan
- The Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Rebecca E Lee
- Department of Anesthesiology, The Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Brian A Coakley
- Department of Surgery and Pediatrics, The Icahn School of Medicine at Mount Sinai, New York, New York, USA
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12
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Lazar A, Chatterjee D, Templeton TW. Error traps in pediatric one-lung ventilation. Paediatr Anaesth 2022; 32:346-353. [PMID: 34767676 DOI: 10.1111/pan.14333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 10/31/2021] [Accepted: 11/03/2021] [Indexed: 01/11/2023]
Abstract
With the advent of thoracoscopic surgery, the benefits of lung isolation in children have been increasingly recognized. However, because of the small airway dimensions, equipment limitations in size and maneuverability, and limited respiratory reserve, one-lung ventilation in children remains challenging. This article highlights some of the most common error traps in the management of pediatric lung isolation and focuses on practical solutions for their management. The error traps discussed are as follows: (1) the failure to take into consideration relevant aspects of tracheobronchial anatomy when selecting the size of the lung isolation device, (2) failure to execute correct placement of the device chosen for lung isolation, (3) failure to maintain lung isolation related to surgical manipulation and isolation device movement, (4) failure to select appropriate ventilator strategies during one-lung ventilation, and (5) failure to appropriately manage and treat hypoxemia in the setting of one-lung ventilation.
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Affiliation(s)
- Alina Lazar
- Department of Pediatric Anesthesia, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Debnath Chatterjee
- Department of Anesthesiology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
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Moreault O, Couture EJ, Provencher S, Somma J, Lohser J, Ugalde PA, Lemieux J, Lellouche F, Bussières JS. Double-lumen endotracheal tubes and bronchial blockers exhibit similar lung collapse physiology during lung isolation. Can J Anaesth 2021; 68:791-800. [PMID: 33594596 DOI: 10.1007/s12630-021-01938-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 11/10/2020] [Accepted: 11/11/2020] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Double-lumen endotracheal tubes (DL-ETT) and bronchial blockers (BB) are frequently used to allow one-lung ventilation (OLV) during video-assisted thoracic surgery (VATS). Recently, faster lung collapse has been documented with a BB than with a DL-ETT. The physiologic mechanisms behind this faster collapse remained unknown. We aimed to measure ambient air absorption (Vresorb) and intra-bronchial pressure (Pairway) into the non-ventilated lung during OLV using DL-ETT and BB. METHODS Patients undergoing VATS and OLV for lung resection were randomly assigned to have measurements made of Vresorb or Pairway within the non-ventilated lung using either a DL-ETT or BB. RESULTS Thirty-nine patients were included in the analyses. The mean (standard error of the mean [SEM]) Vresorb was similar in the DL-ETT and BB groups [504 (85) vs 630 (86) mL, respectively; mean difference, 126; 95% confidence interval [CI], -128 to 380; P = 0.31]. The mean (SEM) Pairway became progressively negative in the non-ventilated lung in both the DL-ETT and the BB groups reaching [-20 (5) and -31 (10) cmH2O, respectively; mean difference, -11; 95% CI, -34 to 12; P = 0.44] at the time of the pleural opening. CONCLUSIONS During OLV before pleural opening, entrainment of ambient air into the non-ventilated lung occurs when the lumen of the lung isolation device is kept open. This phenomenon is prevented by occluding the lumen of the isolation device before pleural opening, resulting in a progressive build-up of negative pressure in the non-ventilated lung. Future clinical studies are needed to confirm these physiologic results and their impact on lung collapse and operative outcomes. TRIAL REGISTRATION www.clinicaltrials.gov (NCT02919267); registered 28 September 2016.
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Affiliation(s)
- Olivier Moreault
- Department of Anesthesiology and Critical Care, Université Laval, Quebec City, QC, Canada
- Department of Anesthesiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec - Université Laval, 2725, Chemin Sainte-Foy, Quebec City, QC, G1V 4G5, Canada
| | - Etienne J Couture
- Department of Anesthesiology and Critical Care, Université Laval, Quebec City, QC, Canada
- Department of Anesthesiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec - Université Laval, 2725, Chemin Sainte-Foy, Quebec City, QC, G1V 4G5, Canada
| | - Steeve Provencher
- Department of Respirology and Thoracic Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Quebec City, QC, Canada
| | - Jacques Somma
- Department of Anesthesiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec - Université Laval, 2725, Chemin Sainte-Foy, Quebec City, QC, G1V 4G5, Canada
| | - Jens Lohser
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | - Paula A Ugalde
- Department of Respirology and Thoracic Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Quebec City, QC, Canada
| | - Jérôme Lemieux
- Department of Anesthesiology and Critical Care, Université Laval, Quebec City, QC, Canada
- Department of Anesthesiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec - Université Laval, 2725, Chemin Sainte-Foy, Quebec City, QC, G1V 4G5, Canada
| | - François Lellouche
- Department of Anesthesiology and Critical Care, Université Laval, Quebec City, QC, Canada
- Department of Anesthesiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec - Université Laval, 2725, Chemin Sainte-Foy, Quebec City, QC, G1V 4G5, Canada
- Research Center, Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Quebec City, QC, Canada
| | - Jean S Bussières
- Department of Anesthesiology and Critical Care, Université Laval, Quebec City, QC, Canada.
- Department of Anesthesiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec - Université Laval, 2725, Chemin Sainte-Foy, Quebec City, QC, G1V 4G5, Canada.
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Goetschi M, Kemper M, Kleine-Brueggeney M, Dave MH, Weiss M. Inflation volume-balloon diameter and inflation pressure-balloon diameter characteristics of commonly used bronchial blocker balloons for single-lung ventilation in children. Paediatr Anaesth 2021; 31:474-481. [PMID: 33406307 DOI: 10.1111/pan.14123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/28/2020] [Accepted: 12/29/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Balloon-tipped bronchial blocker catheters are widely used in pediatric thoracic anesthesia to establish single-lung ventilation. In clinical practice, their balloons demonstrate sudden expansion when inflated with air. In addition, there are concerns related to the high inflation pressures required to expand the balloons. METHODS This in vitro study assessed inflation volume- and inflation pressure-balloon diameter characteristics of the Fogarty arterial embolectomy catheters and Arndt endobronchial blockers. Balloon diameters were photographically assessed during unrestricted volume- and pressure-guided inflation, using air up to the maximum allowed inflation volume as indicated by the manufacturers. Inflation pressures required to open the blocker balloons and inflation pressures needed to expand them to maximum indicated diameter were measured. RESULTS Volume-guided inflation demonstrated a late acute rise in diameter in Fogarty blocker balloons, whereas in the Arndt endobronchial blocker balloons almost linear inflation volume-to-diameter characteristics were observed. Pressure-guided inflation on the other hand demonstrated low-volume, high-pressure characteristics in the Fogarty blocker balloons, with inflation pressures required to expand the balloons to maximum diameters ranging from (mean (SD)) 636 (75) to 947 (152) cmH2 O. The inflation pressures required to open the Fogarty blocker balloons were even >1000 cmH2 O. Inflation pressures required to expand the 5 F, 7 F, and 9 F Arndt endobronchial blocker balloons to maximum indicated diameter were much lower, namely at 218 (15), 252 (28), and 163 (8) cmH2 O. CONCLUSION Based on these study findings, the balloons of Fogarty arterial embolectomy catheters represent high-pressure devices and do not permit stepwise controlled bronchial blockage. The Arndt endobronchial blockers have some advantages over the Fogarty blocker devices, but also represent high-pressure equipment and must be used with caution and limited duration. Manufacturers are asked to design pediatric endobronchial blocker catheters with truly high-volume, low-pressure balloons in accordance to age-related pediatric airway dimensions.
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Affiliation(s)
- Markus Goetschi
- Department of Anesthesia, University Children's Hospital Zurich, Zurich, Switzerland
| | - Michael Kemper
- Department of Anesthesia, University Children's Hospital Zurich, Zurich, Switzerland.,Department of Anesthesiology, RWTH Aachen University Hospital, Aachen, Germany
| | | | - Mital H Dave
- Department of Anesthesia, University Children's Hospital Zurich, Zurich, Switzerland
| | - Markus Weiss
- Department of Anesthesia, University Children's Hospital Zurich, Zurich, Switzerland
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Shin K, Hifumi T, Tsugitomi R, Isokawa S, Shimizu M, Otani N, Ishimatsu S. Empyema with fistula successfully treated with a comprehensive approach including bronchial blocker and embolization receiving veno-venous extracorporeal membrane oxygenation. Acute Med Surg 2021; 8:e621. [PMID: 33604054 PMCID: PMC7871201 DOI: 10.1002/ams2.621] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 11/30/2020] [Indexed: 12/29/2022] Open
Abstract
Background Complicated empyema accompanied by bronchopleural fistula (BPF) has high mortality. The treatment strategy for severe respiratory failure due to empyema with BPF has yet to be established. Case Presentation A 70-year-old man was brought to our hospital and diagnosed with right empyema, BPF (at bronchi B4-10), and secondary left pneumonia. We initiated drainage followed by veno-venous extracorporeal membrane oxygenation due to the severe hypoxia. First, the patient underwent endoscopic treatment with obstructive materials (known as endobronchial Watanabe spigot [EWS]) at B8-10, and was weaned off veno-venous extracorporeal membrane oxygenation on day 7. A secondary EWS was carried out at B4-6. A combination of medical treatments (drainage, antibiotics, nutritional therapy, and rehabilitation) improved his general condition. The patient was able to leave the hospital on foot. Conclusion A comprehensive approach could explain the success of the medical treatment. The principal components are the repeated application of EWS as damage control.
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Affiliation(s)
- Kijong Shin
- Department of Emergency and Critical Care Medicine St. Luke's International Hospital Tokyo Japan
| | - Toru Hifumi
- Department of Emergency and Critical Care Medicine St. Luke's International Hospital Tokyo Japan
| | - Ryosuke Tsugitomi
- Department of Thoracic Medical Oncology The Cancer Institute Hospital of Japanese Foundation for Cancer Research Tokyo Japan
| | - Shutaro Isokawa
- Department of Emergency and Critical Care Medicine St. Luke's International Hospital Tokyo Japan
| | - Masato Shimizu
- Department of Emergency and Critical Care Medicine St. Luke's International Hospital Tokyo Japan
| | - Norio Otani
- Department of Emergency and Critical Care Medicine St. Luke's International Hospital Tokyo Japan
| | - Shinichi Ishimatsu
- Department of Emergency and Critical Care Medicine St. Luke's International Hospital Tokyo Japan
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Morris BN, Fernando RJ, Garner CR, Johnson SD, Gardner JC, Marchant BE, Johnson KN, Harris HM, Russell GB, Wudel LJ, Templeton TW. A Randomized Comparison of Positional Stability: The EZ-Blocker Versus Left-Sided Double-Lumen Endobronchial Tubes in Adult Patients Undergoing Thoracic Surgery. J Cardiothorac Vasc Anesth 2020; 35:2319-2325. [PMID: 33419686 DOI: 10.1053/j.jvca.2020.11.056] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 11/23/2020] [Accepted: 11/24/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To assess if there is a difference in the repositioning rate of the EZ-Blocker versus a left-sided double-lumen endobronchial tube (DLT) in patients undergoing thoracic surgery and one-lung ventilation. DESIGN Prospective, randomized. SETTING Single center, university hospital. PARTICIPANTS One hundred sixty-three thoracic surgery patients. INTERVENTIONS Patients were randomized to either EZ-Blocker or a DLT. MEASUREMENTS AND MAIN RESULTS The primary outcome was positional stability of either the EZ-Blocker or a left-sided double-lumen endobronchial tube, defined as the number of repositionings per hour of surgery and one-lung ventilation. Secondary outcomes included an ordinal isolation score from 1 to 3, in which 1 was poor, up to 3, which represented excellent isolation, and a visual analog postoperative sore throat score (0-100) on postoperative days (POD) one and two. Rate of repositionings per hour during one-lung ventilation and surgical manipulation in left-sided cases was similar between the two devices: 0.08 ± 0.15 v 0.11 ± 0.3 (p = 0.72). In right-sided cases, the rate of repositioning was higher in the EZ-Blocker group compared with DLT: 0.38 ± 0.65 v 0.09 ± 0.21 (p = 0.03). Overall, mean isolation scores for the EZ-Blocker versus the DLT were 2.76 v 2.92 (p = 0.04) in left-sided cases and 2.70 v 2.83 (p = 0.22) in right-sided cases. Median sore throat scores for left sided cases were 0 v 5 (p = 0.13) POD one and 0 v 5 (p = 0.006) POD two for the EZ-Blocker and left-sided DLT, respectively. CONCLUSION For right-sided procedures, the positional stability of the EZ-Blocker is inferior to a DLT. In left-sided cases, the rate of repositioning for the EZ-Blocker and DLT are not statistically different.
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Affiliation(s)
- Benjamin N Morris
- Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC.
| | - Rohesh J Fernando
- Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC
| | - Chandrika R Garner
- Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC
| | - Sean D Johnson
- Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC
| | - Jeffrey C Gardner
- Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC
| | - Bryan E Marchant
- Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC
| | - Kathleen N Johnson
- Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC
| | - Hannah M Harris
- Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC
| | - Gregory B Russell
- Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC; Division of Public Health Sciences\Department of Biostatistics and Data Science
| | - L James Wudel
- Department of Cardiothoracic Surgery, Wake Forest School of Medicine, Winston-Salem, NC
| | - T Wesley Templeton
- Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC
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Matsuoka R, Muneuchi J, Sugitani Y. Successful coil embolisation for an arterio-bronchial fistula in a child presenting catastrophic haemoptysis. Cardiol Young 2020; 30:1744-6. [PMID: 32843106 DOI: 10.1017/S1047951120002681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
We report the case of a 2-year-old girl who developed catastrophic haemoptysis due to an arterio-bronchial fistula after transcatheter balloon dilatation for a narrowing aortopulmonary shunt. We embolised the fistula while haemoptysis was controlled with the left bronchial block ventilation and haemostatic balloon occlusion of the left subclavian artery. An arterio-bronchial fistula is an extremely rare complication for balloon dilatation of an aortopulmonary shunt.
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Abstract
A transgender female patient, who had previously undergone gender-confirming feminisation surgery to the face and larynx, was scheduled for thoracic surgery requiring one-lung ventilation. We encountered unexpected difficult airway management and difficulty inserting an appropriately-sized double-lumen tube. A size 41Fr double-lumen tube, which is selected commonly for biological males, was used eventually for lung isolation and subsequently exchanged for a size 6.5 single-lumen tracheal tube at the end of the case, before successful extubation with a staged extubation set. It is important to highlight the challenges faced, as the care of transgender patients is likely to be unfamiliar to most anaesthetists, despite the increase in the number of gender-confirming procedures performed. Many of these procedures involve the face and airway and can result in significant challenges for airway management, including appropriate sizing of tracheal tubes and their correct placement. It is also possible that patients may not volunteer a history of these procedures and it should be enquired about specifically as part of the anaesthetic pre-assessment.
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Affiliation(s)
- B J Vowles
- Department of Anaesthesia Guy's and St Thomas' NHS Fountdation Trust London UK
| | - I Ahmad
- Department of Anaesthesia Guy's and St Thomas' NHS Fountdation Trust London UK
| | - G Christodoulides
- Department of Anaesthesia Guy's and St Thomas' NHS Fountdation Trust London UK
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19
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Yan J, Rufang Z, Rong W, Wangping Z. Extraluminal Placement of the Bronchial Blocker in Infants Undergoing Thoracoscopic Surgery: A Randomized Controlled Study. J Cardiothorac Vasc Anesth 2020; 34:2435-2439. [PMID: 32178953 DOI: 10.1053/j.jvca.2020.02.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 01/30/2020] [Accepted: 02/05/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The purpose of the present study was to evaluate the efficacy of extraluminal use of the bronchial blocker (BB) for one-lung ventilation (OLV) in infants undergoing thoracoscopic surgery. DESIGN This was a prospective, randomized, controlled clinical study. SETTING University hospital. PARTICIPANTS The study comprised 60 infants undergoing thoracoscopic surgery. INTERVENTION The study included 2 groups. A BB was placed extraluminally for OLV in group A, and a single-lumen endobronchial tube was inserted into the desired mainstem bronchus for OLV in group C. MEASUREMENTS AND MAIN RESULTS The placement time (4.0 ± 0.6 min v 6.3 ± 4.1 min; p = 0.04) and the number of repositions (2 v 11; p = 0.005) were less in group A. There were significant differences in the heart rate and blood pressure after insertion between the 2 groups (p < 0.05). The tidal volumes and end-tidal pressure of carbon dioxide values 10 minutes after the initiation of OLV were similar between the 2 groups (p > 0.05). The incidence of intraoperative hypoxemia was reduced in group A compared with group C (0% v 20%; p = 0.024). No postoperative adverse events were observed in either group. CONCLUSIONS Extraluminal use of the BB may provide a solution for a rapid placement and excellent quality of lung isolation, and it may reduce the incidence of intraoperative hypoxemia in infants without increasing the incidence of hoarseness.
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Affiliation(s)
- Jiang Yan
- Department of Anesthesiology, Shanghai Children's Hospital, Shanghai JiaoTong University, Shanghai, China
| | - Zhang Rufang
- Department of Cardiothoracic Surgery, Shanghai Children's Hospital, Shanghai JiaoTong University, Shanghai, China
| | - Wei Rong
- Department of Anesthesiology, Shanghai Children's Hospital, Shanghai JiaoTong University, Shanghai, China.
| | - Zhang Wangping
- Department of Anesthesiology, Women and Children's Hospital of Jiaxing University, Jiaxing, China
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20
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Langiano N, Fiorelli S, Deana C, Baroselli A, Bignami EG, Matellon C, Pompei L, Tornaghi A, Piccioni F, Orsetti R, Coccia C, Sacchi N, D'Andrea R, Brazzi L, Franco C, Accardo R, Di Fuccia A, Baldinelli F, De Negri P, Gratarola A, Angeletti C, Pugliese F, Micozzi MV, Massullo D, Della Rocca G. Airway management in anesthesia for thoracic surgery: a "real life" observational study. J Thorac Dis 2019; 11:3257-3269. [PMID: 31559028 DOI: 10.21037/jtd.2019.08.57] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background One-lung ventilation (OLV) in thoracic anesthesia is required to provide good surgical exposure. OLV is commonly achieved through a double lumen tube (DLT) or a bronchial blocker (BB). Malposition is a relevant issue related to these devices use. No prospective studies with adequately large sample size have been performed to evaluate the malposition rate of DLTs and BBs. Methods A total of 2,127 patients requiring OLV during thoracic surgery were enrolled. The aim of this multicenter prospective observational study performed across 26 academic and community hospitals is to evaluate intraoperative malposition rate of DLTs and BBs. We also aim to assess: which device is the most used to achieve OLV, the frequency of bronchoscope (BRO) use, the incidence rate of desaturation during OLV and the role of other factors that can correlate to this event, and incidence of difficult airway. Results Malposition rate for DLTs was 14%, for BBs 33%. DLTs were used in 95% of patients and BBs in 5%. Mean positioning time was shorter for DLT than BB (156±230 vs. 321±290 s). BRO was used in 54% of patients to check the correct positioning of the DLT. Desaturation occurred in 20% of all cases during OLV achieved through a DLT. Predicting factors of desaturation were dislocation (OR 2.03) and big size of DLT (OR 1.15). BRO use (OR 0.69) and left surgical side (OR 0.41) proved to be protective factors. Difficult airway prevalence was 16%; 10.8% predicted and 5.2% unpredicted. Conclusions DLT has a low malpositioning rate and is the preferred device to achieve OLV. BRO use recorded was unexpectedly low. The possibility of encountering a difficult airway is frequent, with an overall prevalence of 16%. Risk factors of desaturation are malposition and increased size of DLT. Left procedures and BRO use could lead to fewer episodes of desaturation.
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Affiliation(s)
- Nicola Langiano
- Department of Anesthesia and Intensive Care, University of Udine, Academic Hospital "S. M. della Misericordia", Udine, Italy
| | - Silvia Fiorelli
- Department of Anesthesiology and Intensive care, Sapienza University of Rome, Rome, Italy
| | - Cristian Deana
- Department of Anesthesia and Intensive Care, University of Udine, Academic Hospital "S. M. della Misericordia", Udine, Italy
| | - Antonio Baroselli
- Department of Anesthesia and Intensive Care, University of Udine, Academic Hospital "S. M. della Misericordia", Udine, Italy
| | - Elena Giovanna Bignami
- Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Carola Matellon
- Department of Anesthesia and Intensive Care, University of Udine, Academic Hospital "S. M. della Misericordia", Udine, Italy
| | - Livia Pompei
- UOC Anesthesia and ICM 1. Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
| | - Anna Tornaghi
- Department of Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Federico Piccioni
- Department of Anesthesia, Intensive Care and Palliative Care, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Remo Orsetti
- Anesthesia and ICM DPT of Pulmonary Diseases, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
| | | | - Noemi Sacchi
- School of Anesthesia and Intensive Care, University of Milan, Milan, Italy
| | - Rocco D'Andrea
- U.O. Anesthesia and ICM. A.U.O. Policlinico Sant'Orsola Malpighi, Bologna, Italy
| | - Luca Brazzi
- AOU "Città della Salute e della Scienza" di Turin, University of Turin, Turin, Italy
| | - Carlo Franco
- AOU "Città della Salute e della Scienza" di Turin, University of Turin, Turin, Italy
| | - Rosanna Accardo
- Division of Anesthesia, Department of Anesthesia, Endoscopy and Cardiology, Istituto Nazionale Tumori "Fondazione G. Pascale"-IRCCS, Naples, Italy
| | - Antonio Di Fuccia
- UOC Anesthesia and Postoperative ICM, Cardarelli Hospital, Naples, Italy
| | | | - Pasquale De Negri
- Department of Anesthesia, Intensive Care and Pain Medicine. IRCCS Centro di Riferimento Oncologico della Basilicata/OECI Clinical Cancer Center - Rionero in Vulture, Potenza, Italy
| | | | - Chiara Angeletti
- Operative Unit of Anesthesiology, Intensive Care and Pain Medicine, Civil Hospital G. Mazzini of Teramo, Teramo, Italy. Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Francesco Pugliese
- UOD Anesthesia and ICM of Organ Transplantation, DPT Paride Stefanini, Sapienza University of Rome, Rome, Italy
| | - Marco Valerio Micozzi
- Department of Anesthesiology and Intensive care, Sapienza University of Rome, Rome, Italy
| | - Domenico Massullo
- Department of Anesthesiology and Intensive care, Sapienza University of Rome, Rome, Italy
| | - Giorgio Della Rocca
- Department of Anesthesia and Intensive Care, University of Udine, Academic Hospital "S. M. della Misericordia", Udine, Italy
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Mohtar S, Hui TWC, Irwin MG. Anesthetic management of thoracoscopic resection of lung lesions in small children. Paediatr Anaesth 2018; 28:1035-1042. [PMID: 30281181 DOI: 10.1111/pan.13502] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 08/29/2018] [Accepted: 08/29/2018] [Indexed: 01/06/2023]
Abstract
BACKGROUND Video-assisted thoracoscopic surgery has dramatically increased over the last decade because of both medical and cosmetic benefits. Anesthesia for video-assisted thoracoscopic surgery in small children is more challenging compared to adults due to the considerable problems posed by small airway dimensions and ventilation. The optimal technique for one-lung ventilation has yet to be established and the use of remifentanil infusion in this setting is not well described. AIMS This study investigated the use of extraluminal bronchial blocker placement for one-lung ventilation and the effect of infusion of remifentanil in infants and small children undergoing video-assisted thoracoscopic surgery. METHODS We retrospectively reviewed the technique of one-lung ventilation and the hemodynamic effects of remifentanil infusion in 31 small children during elective video-assisted thoracoscopic surgery for congenital lung lesions under anesthesia with sevoflurane or isoflurane, oxygen, and air. Patients' heart rate, blood pressure, and endtidal carbon dioxide at baseline (after induction of anesthesia), immediately after one-lung ventilation, during carbon dioxide insufflation, and at the end of one-lung ventilation were extracted from the database and analyzed. The use of vasopressors or dexmedetomidine was also recorded and analyzed. RESULTS Extraluminal placement of a bronchial blocker alongside the tracheal tube was successfully performed in 90.3% of cases (28 patients) without any serious complications or arterial oxygen desaturation. There was no significant rise in blood pressure or heart rate even with the rise of endtidal carbon dioxide concentration during video-assisted thoracoscopic surgery. In 58% of patients (18 patients), phenylephrine was administered to maintain the blood pressure within 20% of the baseline value. There was no significant change in the heart rate of all patients at each time point. CONCLUSION One-lung ventilation with an extraluminal parallel blocker was used effectively in this series of young children undergoing thoracoscopic excision of congenital pulmonary lesions. Remifentanil infusion attenuated surgical stress effectively in infants and small children undergoing video-assisted thoracoscopic surgery.
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Affiliation(s)
- Sanah Mohtar
- Department of Anesthesia and Intensive Care, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Theresa W C Hui
- Department of Anaesthesiology, Queen Mary Hospital, Hong Kong, China
| | - Michael G Irwin
- Department of Anaesthesiology, University of Hong Kong, Hong Kong, China
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22
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Templeton TW, Templeton LB, Lawrence AE, Sieren LM, Downard MG, Ririe DG. An initial experience with an Extraluminal EZ-Blocker ® : A new alternative for 1-lung ventilation in pediatric patients. Paediatr Anaesth 2018; 28:347-351. [PMID: 29430803 DOI: 10.1111/pan.13342] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/10/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND The need for 1-lung ventilation in school age, pediatric patients is uncommon and as a result there are relatively few devices available to facilitate lung isolation in this population. Furthermore, little is known about the efficacy and techniques of placement of the currently available devices. One of the newest devices available that may be appropriate in this age group is the EZ-Blocker. AIMS We aimed to examine our initial experience with the EZ-Blocker to evaluate the performance of this device with respect to potential improvements in technique and patient selection going forward. METHODS We performed a retrospective chart review of all pediatric patients who underwent 1-lung ventilation with an EZ-Blocker since the blocker became available at our institution. We recorded demographics, details of placement, intraoperative course, number of repositions, and any postoperative morbidity related to blocker placement or 1-lung ventilation. RESULTS We were able to correctly place the EZ-Blocker and achieve lung isolation in 8 of 11 patients. There was a single episode of repositioning required during 1-lung ventilation with an EZ-Blocker. CONCLUSION The EZ-Blocker was successful in providing lung isolation for a majority of our school age patients. Size constraints in children <6 years of age, excessive secretions, and distortions of tracheal anatomy seemed to be the greatest hindrances to successful placement and positioning of the device. Once correctly positioned, however, the EZ-Blocker may be more stable than the Arndt endobronchial blocker.
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Affiliation(s)
- Thomas Wesley Templeton
- Department of Anesthesiology (Pediatric Anesthesia), Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Leah B Templeton
- Department of Anesthesiology (Pediatric Anesthesia), Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Ann E Lawrence
- Department of Anesthesiology (Pediatric Anesthesia), Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Leah M Sieren
- Department of Surgery (Pediatric Surgery), Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Martina G Downard
- Department of Anesthesiology (Pediatric Anesthesia), Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Douglas G Ririe
- Department of Anesthesiology (Pediatric Anesthesia), Wake Forest School of Medicine, Winston-Salem, NC, USA
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Caddell B, Yelverton B, Tippett JC, Ravi Y, Sai-Sudhakar CB, Culp WC. Management of Massive Hemoptysis After Pulmonary Thromboembolectomy Using a Double Bronchial Blocker System. J Cardiothorac Vasc Anesth 2016; 31:633-636. [PMID: 27884607 DOI: 10.1053/j.jvca.2016.09.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Brandon Caddell
- Department of Anesthesiology, Baylor Scott & White Health, The Texas A&M University Health Science Center College of Medicine, Temple, TX.
| | - Bryan Yelverton
- Department of Anesthesiology, Baylor Scott & White Health, The Texas A&M University Health Science Center College of Medicine, Temple, TX
| | - Jason C Tippett
- Department of Anesthesiology, Baylor Scott & White Health, The Texas A&M University Health Science Center College of Medicine, Temple, TX
| | - Yazhini Ravi
- Division of Cardiothoracic Surgery, Baylor Scott & White Health, The Texas A&M University Health Science Center College of Medicine, Temple, TX
| | - Chittoor B Sai-Sudhakar
- Division of Cardiothoracic Surgery, Baylor Scott & White Health, The Texas A&M University Health Science Center College of Medicine, Temple, TX
| | - William C Culp
- Department of Anesthesiology, Baylor Scott & White Health, The Texas A&M University Health Science Center College of Medicine, Temple, TX
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Walsh K, Park B, Amar D. Segmental Lung Isolation in a Postpneumonectomy Patient Undergoing Contralateral Lung Resection. J Cardiothorac Vasc Anesth 2016; 31:1048-1050. [PMID: 27720492 DOI: 10.1053/j.jvca.2016.07.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Kevin Walsh
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY.
| | - Bernard Park
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - David Amar
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
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Addante RA, Chen J, Goswami S. Successful Management of a Patient With Pulmonary Artery Rupture in a Catheterization Suite. J Cardiothorac Vasc Anesth 2016; 30:1618-1620. [PMID: 27178098 DOI: 10.1053/j.jvca.2016.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Indexed: 11/11/2022]
Affiliation(s)
- Rocco A Addante
- Department of Anesthesiology, Columbia University Medical Center, New York, NY.
| | - Jerri Chen
- Department of Anesthesiology, Columbia University Medical Center, New York, NY
| | - Sumeet Goswami
- Department of Anesthesiology, Columbia University Medical Center, New York, NY
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Templeton TW, Downard MG, Simpson CR, Zeller KA, Templeton LB, Bryan YF. Bending the rules: a novel approach to placement and retrospective experience with the 5 French Arndt endo bronchial blocker in children <2 years. Paediatr Anaesth 2016; 26:512-20. [PMID: 26956889 DOI: 10.1111/pan.12882] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/14/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND One-lung ventilation (OLV) is frequently employed to improve surgical exposure during video-assisted thoracoscopic surgery (VATS) and thoracotomy in adults and children. Because of their small size, children under the age of 2 years are not candidates for some of the methods typically used for OLV in adults and older children, such as a double-lumen endotracheal (DLT) tube or intraluminal use of a bronchial blocker. Due to this, the clinician is left with few options. One of the most robust approaches to OLV in infants and small children has been the extraluminal placement of a 5 French (5F) Arndt endobronchial blocker (AEB). AIM The aim of this retrospective study was to examine and describe our experience with placement and management of an extraluminal 5F AEB for thoracic surgery in children <2 years of age. METHODS We retrospectively examined the anesthetic records for details of AEB placement, arterial blood gas (ABG) data, and intraoperative analgesic prescription in 15 children under the age of 2 years undergoing OLV with a 5F AEB for thoracic surgery at our institution from January 2010 through January 2016. RESULTS We were able to successfully achieve lung isolation in 14 of 15 patients using a 5F AEB that was bent 35-45° 1.5 cm proximal to the inflatable cuff. In 13 of 15 patients, we were able to place the AEB into final position with the aid of video-assisted fiberoptic bronchoscopy. In two patients, fluoroscopy was required to place the 5F AEB into the left mainstem due to poor visualization of the carina and rapid desaturation during bronchoscopy. In one of these patients, even though the blocker appeared to be correctly placed by fluoroscopy, adequate lung isolation was not observed. Intraoperatively, we observed significant degrees of hypercarbia in most patients without oxygen desaturation. Analgesic regimens lacked consistency and varied among patients. Open thoracotomy procedures tended to receive more aggressive narcotic regimens than video-assisted thoracoscopic surgery (VATS) procedures. Fourteen of 15 patients were extubated in the immediate postoperative period. CONCLUSIONS Our technique of placing a 35-45° bend in the AEB, extraluminal placement, and observed manipulation with a video-assisted flexible fiberoptic bronchoscope (FFB) within the trachea can be used to achieve consistent lung isolation in patients <2 undergoing thoracic surgery. When the use of a FFB proves unsuccessful, fluoroscopy can provide an alternative solution to successful placement. Significant respiratory derangements without long-term sequelae will occur in a majority of these patients during OLV. Several different approaches to intraoperative analgesia did not impede extubation in the early postoperative period.
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Affiliation(s)
- T Wesley Templeton
- Department of Anesthesiology Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, USA
| | - Martina G Downard
- Department of Anesthesiology Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, USA
| | - Christopher R Simpson
- Department of Anesthesiology Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, USA
| | - Kristen A Zeller
- Department of Pediatrics (Section on Pediatric Surgery), Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, USA
| | - Leah B Templeton
- Department of Anesthesiology Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, USA
| | - Yvon F Bryan
- Department of Anesthesiology Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, USA
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Abstract
The development and evolution of the endotracheal tube (ETT) have been closely related to advances in surgery and anesthesia. Modifications were made to accomplish many tasks, including minimizing gross aspiration, isolating a lung, providing a clear facial surgical field during general anesthesia, monitoring laryngeal nerve damage during surgery, preventing airway fires during laser surgery, and administering medications. In critical care management, ventilator-associated pneumonia (VAP) is a major concern, as it is associated with increased morbidity, mortality, and cost. It is increasingly appreciated that the ETT itself is a primary causative risk for developing VAP. Unfortunately, contaminated oral and gastric secretions leak down past the inflated ETT cuff into the lung. Bacteria can also grow within the ETT in biofilm and re-enter the lung. Modifications to the ETT that attempt to prevent bacteria from entering around the ETT include maintaining an adequate cuff pressure against the tracheal wall, changing the material and shape of the cuff, and aspirating the secretions that sit above the cuff. Attempts to reduce bacterial entry through the tube include antimicrobial coating of the ETT and mechanically scraping the biofilm from within the ETT. Studies evaluating the effectiveness of these modifications and techniques demonstrate mixed results, and clear recommendations for which modification should be implemented are weak.
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Affiliation(s)
| | | | | | - Ross Blank
- Department of Anesthesiology, University of Michigan Health System, Ann Arbor, Michigan
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Hulse E, Reed FC, Eddleston M, Etherington R, Clutton RE. A model describing the use of a bronchial blocking device and a sheathed bronchoscope for pulmonary aspiration studies in the Gottingen minipig. Lab Anim 2014; 48:164-9. [PMID: 24496573 PMCID: PMC4017320 DOI: 10.1177/0023677213518526] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The administration of test substances into a single lung, or lung lobe, allows the remaining untreated lung to act as an experimental control and effectively halves the number of animals required in a given experiment. It reduces the likelihood of early fatal pulmonary failure when noxious substances are studied which may lessen the need for replacement animals. However, the ease of substance administration and the subsequent analysis of its effects, for example by bronchoalveolar lavage or bronchoscopy, depend critically on the size of the animal model. The advantages of using minipigs; ease of handling, reduced housing requirements, genetic homogeneity, etc. are reduced if their diminutive size makes lung studies difficult. This article describes the use of a bronchial blocking device and a sheathed bronchoscope which enabled sterile endobronchial substance administration in Göttingen minipigs, and allowed pulmonary aspiration studies to be conducted with each animal acting as its own control.
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Affiliation(s)
- E Hulse
- Pharmacology, Toxicology and Therapeutics, Centre for Cardiovascular Science, Queens Medical Research Institute, University of Edinburgh, Edinburgh, UK
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Kus A, Hosten T, Gurkan Y, Gul Akgul A, Solak M, Toker K. A comparison of the EZ-Blocker with a Cohen Flex-Tip blocker for one-lung ventilation. J Cardiothorac Vasc Anesth 2013; 28:896-9. [PMID: 23958073 DOI: 10.1053/j.jvca.2013.02.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Indexed: 11/11/2022]
Abstract
OBJECTIVES The EZ-Blocker (IQ Medical Ventures BV, Rotterdam, Netherlands) is a newly designed device for one-lung ventilation. The aim of this study was to compare the effectiveness of the Cohen Flex-Tip bronchial blocker (Cook, Bloomington, IN) and the EZ-Blocker for one-lung ventilation during thoracic surgery. DESIGN Randomized and prospective. SETTING A university hospital. PARTICIPANTS This study included 40 patients undergoing thoracic surgical procedures. INTERVENTIONS Patients were assigned to 2 study groups: Patients who received the Cohen Flex-Tip blocker were assigned to the Cohen group, and patients who received the EZ-Blocker were assigned to the EZ group. In both groups, fiberoptic guidance was used during placement of the bronchial blockers. Comparisons between the groups included the time to correct placement, the incidence of malpositioning, and the satisfaction level of the surgeon (good, fair, poor). MEASUREMENTS AND MAIN RESULTS One-lung ventilation was achieved successfully for all patients. The time to correct placement (mean±SD) was significantly shorter in the EZ group (146±56 seconds) compared with the Cohen group (241±51 seconds; p=0.01). The incidence of malpositioning was significantly lower in the EZ group compared with the Cohen group (p=0.018). Surgeon satisfaction was similar in both groups. CONCLUSIONS In this study, both bronchial blockers provided similar surgical exposure during thoracic procedures. The EZ-Blocker had a shorter time to correct positioning and less frequent intraoperative malpositioning.
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Affiliation(s)
- Alparslan Kus
- Department of Anesthesiology and Reanimation, Medical Faculty of Kocaeli University, Umuttepe, Kocaeli, Turkey.
| | - Tulay Hosten
- Department of Anesthesiology and Reanimation, Medical Faculty of Kocaeli University, Umuttepe, Kocaeli, Turkey
| | - Yavuz Gurkan
- Department of Anesthesiology and Reanimation, Medical Faculty of Kocaeli University, Umuttepe, Kocaeli, Turkey
| | - Aslı Gul Akgul
- Department of Thoracic Surgery, Medical Faculty of Kocaeli University, Umuttepe, Kocaeli, Turkey
| | - Mine Solak
- Department of Anesthesiology and Reanimation, Medical Faculty of Kocaeli University, Umuttepe, Kocaeli, Turkey
| | - Kamil Toker
- Department of Anesthesiology and Reanimation, Medical Faculty of Kocaeli University, Umuttepe, Kocaeli, Turkey
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Marciniak D, Kraenzler E. Airway management and lung isolation in a patient with a massive cavernous hemangioma of the tongue. J Cardiothorac Vasc Anesth 2012; 27:1337-8. [PMID: 22592138 DOI: 10.1053/j.jvca.2012.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Indexed: 11/11/2022]
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