One Lung Extraluminal Bronchial Blocker

Abstract

Introduction: This video shows the various methods employed for one lung ventilation (OLV) for thoracoscopic surgery in infants and toddlers. Currently, there are no best practice guidelines on the best method to achieve OLV in this challenging patient population. The different methods include main stem intubation, double lumen tubes, and extraluminal bronchial blockers.1 Extraluminal bronchial blocker for OLV has unique advantages for infants and smaller children that balances the needs of both the surgical and anesthesia providers. We demonstrate a standard method for extraluminal bronchial blocker placement in an infant and a novel modification of the technique that facilitates more accurate blocker placement into the target bronchus.2 The rationale for a multicenter study of OLV techniques in infants is presented as next steps are discussed. Materials and Methods: A novel modification for the technique of extraluminal bronchial blocker for OLV using an uncuffed tube facilitates deployment of the bronchial blocker. To start, the endotracheal tube (ET) here is placed through video laryngoscopy. A flexible fiberoptic endoscope is then used to ensure correct placement into the left main stem. The bronchial blocker is then deployed directly into the left mainstem through the main stemmed endotracheal tube. While holding the blocker in place, The ET tube is then removed from the trachea over the external portion of the blocker shaft. Next, under direct or video laryngoscopy, a new ET tube is positioned in the trachea and anterior to the now extraluminal/endotracheal bronchial blocker. Flexible bronchoscopy through the ET tube is then used to observe the bronchial blocker in the left bronchus and the balloon is inflated once placement is confirmed. Results: Effective placement of extraluminal bronchial blockers into the left mainstem can be achieved with this novel modification to placement. Conclusions: The primary literature on this subject is limited and there are no best practice guidelines at this time. Small single-center studies have shown that extraluminal bronchial blockers are associated with less hypoxemia and hypercarbia.3 The novel modification to the placement of extraluminal bronchial blockers described in this video may help with ease of placement and encourage wider adoption of this technique. There is a need for multicenter study to adequately determine the most effective method for OLV that maximizes the safety profile for patients, ensures ease of placement for the anesthesia providers, and maintains quality lung isolation for the surgeon. No competing financial interests exist. Author(s) have received and archived patient consent for video recording/publication in advance of video recording of procedure. Runtime of video: 5 mins