Efficacy of routine extraluminal use of Arndt endobronchial blocker for one-lung ventilation in infants

Abstract

Objective To evaluate the efficacy of routine extraluminal use of an Arndt endobronchial blocker (AEB) for one-lung ventilation (OLV) in infants. Methods Thirty American Society of Anesthesiologists physical status Ⅰ or Ⅱ infants, aged 6-36 months, weighing 5-18 kg, undergoing elective thoracoscopic surgery, were enrolled in the study.The loop of AEB was fastened to the front of the endotracheal tube (ETT), and the blocker was placed externally to the ETT.After induction of general anesthesia, the AEB′s placement was facilitated through the use of a fibreoptic bronchoscope.Mean arterial pressure, heart rate, end-tidal pressure of carbon dioxide, oxygen saturation and airway pressure were recorded before AEB placement (T1), during AEB placement (T2), at the beginning of OLV (T3), at the beginning of two lung ventilation (T4) and at extubation (T5). The AEB placement time and successful placement and lung collapse time were recorded.The satisfaction with lung collapse, AEB shifting, hoarseness and development of intraoperative adverse cardiovascular events and hypoxemia and hypoventilation during OLV were recorded. Results Compared with the baseline at T1, no significant change was found in heart rate or mean arterial pressure at the other time points (P>0.05), airway pressure was significantly increased at T2, 3, and end-tidal pressure of carbon dioxide was increased at T4 (P<0.05). The AEB placement time was (5.6±1.2) min, the success rate of AEB placement 93%, the rate of satisfaction with lung collapse 83%, and the incidence of AEB shifting (only found in the pediatric patients in whom AEBs were placed on the right side) 13%.No intraoperative adverse cardiovascular events, hypoxemia or hypoventilation was observed in the pediatric patients in whom AEBs were successfully placed. Conclusion Routine extraluminal use of an AEB can provide a fast, safe and effective method for OLV in infants. Key words: Child; Respiration, artificial; Intubation, intratracheal