One-lung ventilation management for thoracic surgeries in pediatric oncology

Abstract

Treatment of children with mediastinal and lung tumors is an urgent problem in both surgery and anesthesiology. Main goal is to grant optimal conditions for the surgery — collapse of the lung on the side of the operation, while maintaining adequate oxygenation and efficient transport of oxygen to the tissues. The choice of devices for carrying out one-lung ventilation is the most important factor determining the safety of the patient. Aim. To increase the efficiency and safety of anesthesia for thoracic surgeries in children due to the use of bronchial blockers for one-lung ventilation. Materials and methods. 70 surgeries were performed (38 — thoracoscopic, 32 — thoracotomies) in 70 patients. Patients were randomly divided into two groups: Study Group (BB) (n = 56) — one-lung ventilation was performed using bronchial blocker; Control group (DLT) (n = 14) — one-lung ventilation was performed using a double-lumen tube. Ventilation parameters, hemodynamics, the incidence of complications in the perioperative and postoperative periods were recorded. Results. A much less prolonged intubation of the trachea time in BB group was found compared to the DLT group (55.36 ± 26.34 sec versus 97.0 ± 7.09 sec, respectively, p < 0.0001) and a lower frequency of repositioning (0.2 ± 0.4 and 0.57 ± 0.51, respectively, p = 0.04). In patients with bronchial blockers, less complications were recorded, such as postoperative aphonia and sore throat. Conclusion. An analysis of obtained results allows the assertion that bronchial blockers demonstrate greater efficacy in comparison with double-lumen tubes. They provide faster intubation than DLT, irrespective of the side of the surgery, allow complete collapse of the lung with a less frequent need for repositioning. The introduction of a new method of one-lung ventilation with the use of bronchial blockers in children will improve the results of surgeries by providing adequate conditions for the surgical team, reducing the length of stay of patients in the intensive care unit during the postoperative period due to the reduction in complications such as trauma of the main bronchi, aphonia and sore throat.