The effectiveness of ARNDT endobronchial blockers in paediatric scoliosis surgery

Abstract

Introduction: Although described for paediatric thoracic surgery (1), there is little data on the use of the Arndt endobronchial blocker in paediatric spinal deformity surgery. We present its successful application in these patients.Methods: Thirteen patients undergoing surgical correction of scoliosis involving a lateral thoracotomy anterior approach were suitable for lung isolation using an Arndt endobronchial blocker. Placement was via an armoured tracheal tube; the endobronchial blockers were 5 or 9 FG with low‐volume low‐pressure cuffs (spherical or elliptical balloons). Placement was by a paediatric anaesthetist trained in paediatric bronchoscopy and required a 2.2 or a 2.8 mm paediatric fibreoptic bronchoscope.Results: Patient ages ranged from 18 months to 18 years and weights from 9 kg to 71 kg. All had idiopathic or congenital scoliosis; one patient underwent a VEPTR procedure. In all 13 patients, placement was easily and promptly achieved with no incorrect placements, displacements (including after patient repositioning), or failures to isolate one lung. Median time of insertion was 5 min (with checks), speed of insertion increasing as experience improved. Inflation times for the blocker balloon ranged from 1.5 h to 5 h. There was no airway trauma; direct bronchial inspection revealed local erythema only. Saturations were supported with 5 cm CPAP to the isolated lung and one‐lung ventilation was well tolerated in all but one patient with acceptable airway pressures (<35 cm water); this one patient required partial lung inflation (blocker in place, balloon not inflated) to maintain adequate saturations and airway pressures. The surgical field was excellent in all cases.Discussion: Complex paediatric spinal surgery may require lung collapse to improve spinal access, and is traditionally achieved using a double‐lumen tracheal tube. Difficulties can arise as the children are often small for age with potentially distorted airway anatomy and there are a limited number of double lumen tube sizes. This can lead to inadequate isolation, a poor surgical field, endobronchial cuff herniation or obstruction of left upper lobe (tube too small or too long). The careful use of the Arndt endobronchial blocker avoids all these problems and enables easy reliable and safe isolation. Potential complications include malposition, migration, and direct airway trauma, allied to the usual complications of one lung anaesthesia. In our series, there were no complications relating to its use and insertion was quick and straightforward.Conclusions: Lung isolation with the Arndt endobronchial blocker is both safe and very effective in paediatric spinal deformity surgery.Reference 1 Wald SH, Mahajan A, Kaplan MB et al. Experience with the Arndt paediatric bronchial blocker. Br J Anaesth 2005; 94: 92–94.