Use Of Bronchial Blocker Research Articles

The association between double-lumen tube versus bronchial blocker and postoperative pulmonary complications in patients after lung cancer surgery.

BackgroundBoth double-lumen tube (DLT) and bronchial blocker (BB) are used for lung isolation in patients undergoing lung cancer surgery. However, the effects of different devices for lung isolation remain inconclusive. Present study was designed to investigate the association between the choice of the two devices and postoperative pulmonary complications (PPCs) in patients with lung cancer.MethodsIn this retrospective cohort study, patients who underwent lung cancer surgery between January 1, 2020 and October 31, 2020 were screened. Patients were divided into two groups according to different devices for lung isolation: DLT group and BB group. Primary outcome was the incidence of a composite of PPCs during postoperative in-hospital stay.ResultsA total of 1721 were enrolled for analysis, of them, 868 received DLT and 853 BB. A composite of PPCs was less common in patients with BB (25.1%, [214/853]) than those received DLT (37.9% [329/868] OR 0.582 95% CI 0.461-0.735 P < 0.001). Respiratory infection was less common in BB group (14.4%, [123/853]) than DLT group (30.3%, [263/868], P<0.001). The incidence of non-PPCs complications was not statistically significant between the 2 groups.ConclusionsFor patients undergoing surgery for lung cancer, the use of BB for lung isolation was associated with a reduced risk of PPCs when compared with DLT.

Anaesthetic management for excision of rare right pulmonary glial heterotopia in a post COVID-19 survival paediatric patient.

Sir, Pulmonary glial heterotopia is a rare condition in which lung cyst is lined with glial tissue. The affected children usually present with difficulty in breathing at a young age without any other congenital anomalies.[1] Herein we describe the case of a 1-year-old boy weighing 10 kg who presented with shortness of breath (SOB) and dry cough since last one month to the paediatric surgery department. The SOB was gradual in onset and progressive in nature. The child had similar type of symptoms five months back for which a local practitioner had been consulted. The child was put on anti-tubercular treatment. On non-relief of symptoms, he was referred to us. The chest radiogram and computed tomography scan showed an 8.5 × 5.6 × 7.2 cm cyst in the lower lobe of the right lung [Figure 1 and 2]. In the meantime patient developed productive cough and fever. Reverse transcription -polymerase chain reaction (RT-PCR)test for coronavirus disease (COVID)-19 was advised and it was positive. The patient was medically managed and discharged home.Figure 1: Chest x-ray showing large cyst in right lungFigure 2: CT chest showing right lung cystThoracotomy and excision of right lung cyst was planned after patient fully recovered from COVID-19 pneumonitis and became RT-PCR negative. On preoperative examination all vital parameters were within normal ranges. The patient was wheeled into operation theatre and connected to routine monitoring. Premedication was done with intravenous [IV] midazolam 0.5 mg and intravenous fentanyl 15 mg. Induction was done with IV thiopentone sodium 50 mg and IV atracurium 5 mg bolus followed by intubation with a cuffed 4.5-mm endotracheal tube. A single lumen tube was used due to unavailability of an appropriately sized double lumen tube or bronchial blockers. Moreover, there is still a lack of consensus on lung isolation techniques in infants. The patient was put on mechanical ventilation with tidal volume [TV] 100 mL, frequency 10 and peak airway pressure 10 cm H2O. Surgery was performed in left lateral position. Intraoperatively transient electrocardiography changes were observed during manipulation, which resolved without any intervention. Maintenance was achieved via a 40:60 ratio of oxygen and nitrous oxide, sevoflurane and intermittent aliquots of atracurium. After 30 minutes there was drop in oxygen saturation (SpO2) to 85%, the patient was switched to manual ventilation. A large cyst was removed via right posterolateral thoracotomy, and an intercostal drain [ICD] was placed. On completion of the procedure, the patient was moved into the supine position. Extubation was performed successfully on the operating theatre table. After observing the patient for 15 minutes he was shifted to the paediatric intensive care unit. On the fifth postoperative day ICD was removed and he was discharged from the hospital. Histopathology revealed rare lung cyst glial heterotopia. In unilateral lung disease, an optimal ventilation-perfusion match can be achieved with the lateral decubitus position. In this position, during surgery the healthy lung occupies a dependent position and therefore it receives maximum perfusion and ventilation.[2] Various lung isolation methods have been described in the literature, such as the use of bronchial blockers, double-lumen tubes, and uniblocker tubes. The advantage of using a single lumen tube is that it is easy to insert, but there may be inadequate collapse of the diseased lung.[3] Children have smaller airways and the smallest double lumen tube is size 26 Fr, which is suitable for children aged >8 years. For smaller children, placement of a single lumen tube into the desired bronchus or the use of bronchial blockers is recommended.[4] With endobronchial tube placement, switching from one-lung ventilation to two-lung ventilation is difficult, and the tube may get blocked frequently by blood or secretions. A bigger-sized tube may cause bronchial injury.[56] Manual ventilation improved SpO2 because the anaesthesiologists were able to regulate tidal volume and peak airway pressure by constantly adjusting the adjustable pressure limiting valve in synchronisation with surgical steps. It is common in post-COVID-19 patients to have residual shortness of breath and deranged pulmonary function tests suggestive of restrictive lung disease.[7] The COVID-19 survival child presenting with a history of increasing breathlessness had a rare lung cyst. Double lung ventilation was planned and minute ventilation was maintained by dynamically adjusting TV and respiratory rate with manual ventilation. In conclusion, we want to emphasise the fact that paediatric thoracotomy should not be avoided due to a lack of ideal resources like double lumen tubes, bronchial blockers, paediatric ventilators. Notably, however, clinicians must remain vigilant and should take all necessary precautions. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Current Practice Issues in Thoracic Anesthesia.

This review discusses the present strategies in lung separation, the various types of double-lumen tubes (DLTs), and the use of bronchial blockers (BBs). Methods of selecting the correct DLT size and the role of videolaryngoscopy in placing a DLT are reviewed. Mechanisms whereby inhaled anesthetics may be protective during one-lung ventilation (OLV) are highlighted. The risk and prevention of fire during thoracic procedures are discussed.

Awake fiberoptic intubation and use of bronchial blockers in ankylosing spondylitis patients.

BACKGROUNDPatients with ankylosing spondylitis (AS) combined with severe cervical fusion deformity have difficult airways. Awake fiberoptic intubation is the standard treatment for such patients. Alleviating anxiety and discomfort during intubation while maintaining airway patency and adequate ventilation is a major challenge for anesthesiologists. Bronchial blockers (BBs) have significant advantages over double-lumen tubes in these patients requiring one-lung ventilation.AIMTo evaluate effective drugs and their optimal dosage for awake fiberoptic nasotracheal intubation in patients with AS and to assess the pulmonary isolation effect of one-lung ventilation with a BB.METHODSWe studied 12 AS patients (11 men and one woman) with lung or esophageal cancer who underwent thoracotomy with a BB. Preoperative airway evaluation found that all patients had a difficult airway. All patients received an intramuscular injection of penehyclidine hydrochloride (0.01 mg/kg) before anesthesia. In the operating room, dexmedetomidine(0.5 μg/kg) was infused intravenously for 10 min, with 2% lidocaine for airway surface anesthesia, and a 3% ephedrine cotton swab was used to contract the nasal mucosa vessels. Before tracheal intubation, fentanyl (1 μg/kg) and midazolam (0.02 mg/kg) were administered intravenously. Awake fiberoptic nasotracheal intubation was performed in the semi-reclining position. Intravenous anesthesia was administered immediately after successful intubation, and a BB was inserted laterally. The pre-intubation preparation time, intubation time, facial grimace score, airway responsiveness score during the fiberoptic introduction, time of end tracheal catheter entry into the nostril, and lung collapse and surgical field score were measured. Systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) were recorded while entering the operation room (T1), before intubation (T2), immediately after intubation (T3), 2 min after intubation (T4), and 10 min after intubation (T5). After surgery, all patients were followed for adverse reactions such as epistaxis, sore throat, hoarseness, and dysphagia.RESULTSAll patients had a history of AS (20.4 ± 9.6 years). They had a Willson's score of 5 or above, grade III or IV Mallampati tests, an inter-incisor distance of 2.9 ± 0.3 cm, and a thyromental (T-M) distance of 4.8 ± 0.7 cm. The average pre-intubation preparation time was 20.4 ± 3.4 min, intubation time was 2.6 ± 0.4 min, facial grimace score was 1.7 ± 0.7, airway responsiveness score was 1.1 ± 0.7, and pulmonary collapse and surgical exposure score was 1.2 ± 0.4. The SBP, DBP, and HR at T5 were significantly lower than those at T1-T4 (P < 0.05). While the values at T1 were not significantly different from those at T2-T4 (P > 0.05), they were significantly different from those at T5 (P < 0.05). Seven patients had minor epistaxis during endotracheal intubation, two were followed 24 h after surgery with a mild sore throat, and two had hoarseness without dysphagia.CONCLUSIONPatients with AS combined with severe cervical and thoracic kyphosis should be intubated using fiberoptic bronchoscopy under conscious sedation and topical anesthesia. Proper doses of penehyclidine hydrochloride, dexmedetomidine, fentanyl, and midazolam, combined with 2% lidocaine, administered prior to intubation, can provide satisfactory conditions for tracheal intubation while maintaining the comfort and safety of patients. BBs are safe and effective for one-lung ventilation in such patients during thoracotomy.

Use of bronchial blocker to facilitate left double-lumen tube placement.

Use of bronchial blocker to facilitate left double-lumen tube placement.

Use of bronchial blockers for thoracic surgery in pediatric oncology

Introduction. 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 (OLV) is the most important factor determining the safety of the patient.Aim of the study. To increase the efficiency and safety of anesthesia for thoracic surgeries in children due to the use of bronchial blockers (BB) for one-lung ventilation (OLV). Materials and methods. 92 surgeries were performed (49 – thoracoscopic, 43 – thoracotomies) in 11–17 years old 92 patients. Patients were randomly divided into two groups: BB group (n = 56) – OLV was performed using bronchial blocker; double-lumen tubes (DLT) group (n = 36) – OLV was performed using a DLT. Ventilation parameters, hemodynamics, the incidence of complications in the perioperative and postoperative periods were recorded.Results. A much less prolonged lungs separation time in BB group was found compared to the DLT group (65.32 ± 17.32 sec versus 99.0 ± 9.03 sec respectively, p &lt; 0.0001) and a lower frequency of repositioning (0.2 ± 0.4 and 0.57 ± 0.51 respectively, p = 0.04). In patients with BB, less complications were recorded, such as postoperative aphonia and sore throat.Conclusion. BB demonstrate efficacy and safety in OLV management for thoracic surgeries in pediatric oncology. They provide faster lungs separation time than DLT, irrespective of the side of the surgery, allow complete collabation of the lung with a less frequent need for repositioning. The introduction of a new method of OLV with the use of BB in children is associated with reduction of 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.

A survey of one-lung ventilation device in lung resection surgeries in Taiwan—A population-based nationwide cohort study

Double-lumen endotracheal tubes and bronchial blockers are the two lung separation devices most commonly used for lung resection. The preference and outcomes of choosing different lung separation devices have not been discussed in the literature. This study was conducted using the data of 2 million patients randomly chosen from the National Health Insurance Research Database between 2011 and 2016. We selected patients who underwent lung resection surgery and surveyed their demographic data and trends of double-lumen endotracheal tube and bronchial blocker use. To determine the influence of endotracheal tubes on clinical outcomes, we computed multiple linear regressions of the number of deaths within 30 days after surgery, intensive care unit stay, hospital stay, and medical cost. The use of bronchial blockers in Taiwan has steadily increased from 6.13% to 11.33% from 2011 to 2016. Anaesthesiologists working in regions with higher thoracic surgery volumes preferred bronchial blockers over double-lumen endotracheal tubes. Bronchial blockers were the preferred choice in women, elderly individuals, patients with more comorbidities, and those undergoing video-assisted thoracoscopic surgeries. After adjustment for sex, age, Charlson Comorbidity Index, and video-assisted thoracoscopic surgeries, we found that patients in whom bronchial blockers were applied had shorter hospital stays. The use of bronchial blockers is increasing as the experience of anaesthesiologists increases. Although double-lumen endotracheal tubes remain the principal choice for lung separation in Taiwan, clinical outcomes of the bronchial blocker group were not inferior to those of the double-lumen endotracheal tube group.

A novel method of Uniblocker placement: extraluminal technique supported by trachea length measurement: A CONSORT-compliant article.

Background:The use of bronchial blockers has been increased for one-lung ventilation; however, the placement of bronchial blockers is time consuming. The objective of this study was to compare the novel extraluminal technique of Uniblocker placement supported by trachea length measurement on computerized tomography images with conventional intraluminal Uniblocker placement method.Methods:Seventy adult patients undergoing left side thoracic surgery were included in the study. All the patients were randomly assigned to one of two groups: conventional intraluminal intubation group (CV-IN group, n = 35) or extraluminal CT guided group (CT-EX group, n = 35). The primary endpoints were the optimal positions of Uniblocker and the injuries of bronchi and carina. The secondary outcomes included the time of Uniblocker placement, the adequacy of lung collapse, the incidences of Uniblocker displacement, sore throat, and hoarseness postoperative.Results:In the CV-IN group, 19 of 35 Uniblockers went to the left main-stem bronchus on the initial blind insertion and 15 of 35 Uniblockers were considered as in optimal depth, whereas in the CT-EX group, 32 of 35 Uniblockers went to the left main-stem bronchus on the initial blind insertion and 31 of 35 Uniblockers were considered as in optimal depth (P < .01). The incidence of bronchi and carina injuries was obviously lower in the CT-EX group (occurred in 1 of 35 cases) than that in the CV-IN group (occurred in 8 of 35 cases) (P < .05). The time of Uniblocker placement took 145.4 s in the CV-IN group and 85.4 s in the CT-EX group (P < .01). The malpositions of Uniblocker, the degree of pulmonary collapse and the adverse events postoperative such as sore throat and hoarseness were not significantly different between the two groups (P > .05).Conclusion:The novel extraluminal technique of Uniblocker placement supported by trachea length measurement on computerized tomography images was proved to be more rapid, more accurate and less complications than conventional intraluminal Uniblocker placement method.

Use of bronchial blocker in emergent thoracotomy in presence of upper airway hemorrhage, and cervical spine fracture: a difficult decision

Female, 85 y.o., weighting 60kg, multiple trauma patient. After an initial laparotomy, an emergent thoracotomy was performed using a bronchial blocker for lung isolation (initial active suction was applied). During surgery, bronchial cuff was deflated, causing a self-limited tracheal blood flooding. A second lung isolation was attempted but it was not as effective as initially. Probably, a lung collapse with the same bronchial blocker was impaired in the second attempt because of the obstruction of bronchial blocker lumen by intraoperative endobronchial hemorrhage. Bronchial blocker active suction may contribute to obtain or accelerate lung collapse, particularly in patients that do not tolerate ventilator disconnection technique or lung surgical compression. The use of bronchial blockers technology was a valuable alternative to double lumen tubes in this case of emergent thoracotomy in the context of a patient having thoracic, abdominal trauma, severe laceration of tongue and apophysis odontoid fracture associated to massive hemorrhage, despite several pitfalls that could compromise its use. The authors intend to discuss the advantages and disadvantages of bronchial blockers comparing to double-lumen tubes for lung isolation, and the risks of our approach, in this complex multitrauma case.

Pediatric Pulmonary Artery Rehabilitation: A Review of Our Experience and a Novel Approach Using Bronchial Blockers.

Recent advances in the field of pediatric interventional cardiology have resulted in therapies for patients in need of augmented pulmonary artery (PA) flow. Catheter-based PA rehabilitation can be performed safely but not without the potential risk of pulmonary hemorrhage. When severe, this bleeding has the ability to contaminate the bronchi and trachea, and possibly occlude the endotracheal tube. This can result in a critical inability to ventilate and oxygenate these patients. Herein, we review our institutional experience with pulmonary hemorrhage associated with these procedures and the feasibility of predicting this outcome. The secondary aim was to discuss our novel anesthetic approach to a select group of these patients, involving the use of bronchial blockers to preemptively prevent contamination of bilateral bronchi and occlusion of the endotracheal tube.

One-lung ventilation management for thoracic surgeries in pediatric oncology

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 &lt; 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.

Bronchial Blocker Versus Left Double-Lumen Endotracheal Tube for One-Lung Ventilation in Right Video-Assisted Thoracoscopic Surgery

The aim of this study was to compare the quality of lung deflation of a left-sided double-lumen endotracheal tube (DLT) with a bronchial blocker (BB) for one-lung ventilation in video-assisted thoracic surgery (VATS). A prospective, randomized, clinical study. A university-affiliated teaching hospital. Forty-five adult patients undergoing esophageal tumor surgery using VATS with right lung deflation. Patients were assigned by a computer-generated randomization sequence to either the left-sided DLT or BB group. The correct positioning of the airway device was confirmed using fiberoptic bronchoscopy. The variables assessed included: (1) time required to correctly place the devices and to achieve lung collapse; (2) the number of times the device malpositioned; (3) the quality of lung deflation as rated by the surgeon; (4) blood pressure and heart rate at baseline (T1), immediately before (T2) and after (T3) and 1 minute (T4) after intubation; (5) the number of patients with hypoxemia (SpO2 < 90%) during the one-lung ventilation (OLV) period; and (6) postoperative hoarseness of voice, sore throat, or pulmonary infection. Of the 45 patients approached for the study, 21 patients in the DLT group and 19 patients in the BB group were analyzed. The time required to place the device in the correct position was similar between the 2 groups. The time to achieve right lung collapse in the BB group was significantly longer (mean difference: 3.232, 95% confidence interval [CI]: 1.993-4.471; p = 0.003). The quality of lung collapse, OLV duration, number of patients with device malposition, and hypoxemia in both groups were similar. There were more patients suffering hoarseness (odds ratio [OR]: 4.85, 95% CI: 1.08-21.76; p = 0.034) or sore throat (OR: 4.29, 95% CI: 1.14-16.18; p = 0.030) in the DLT group, while no patients developed postoperative lung infection in either group. Compared to T1, systolic blood pressure (sBP), diastolic BP (dBP), and heart rate (HR) at T2 in both groups were higher (p < 0.05) in the DLT group. Then, compared to T2, sBP and dBP at T3 and T4 and HR at T3 in the DLT group were higher (p < 0.05). The results of this study showed that BB is an effective alternative for left one-lung ventilation in right VATS, but requires a longer time to achieve complete lung collapse. Moreover, the use of BB caused less hemodynamic perturbation and can reduce postoperative hoarseness and sore throat.

気管支ブロッカー留置の工夫により施行し得た肺動静脈瘻に対する小児完全胸腔鏡下肺葉切除術

幼児以下の小児は分離肺換気が困難であることから，鏡視下手術は広く普及していない．今回我々は肺動静脈瘻を有する4歳児平均相当の体格をした7歳女児に対して，完全胸腔鏡下肺葉切除術を安全に施行し得た．分離肺換気に際して，気管挿管前に気管支ブロッカーを留置する麻酔管理を行った．気管支ブロッカーがチューブ外にあるため，気管チューブが細くても気管支鏡操作と気管支ブロッカーとが干渉せず，良好な位置を保持し得た．気管支ブロッカー留置の工夫が，良好な分離肺換気とworking spaceの確保を可能とし，小児における安全な完全胸腔鏡下肺葉切除術の実施に有用と考えられた．

Pro: bronchial blockers should be used routinely for providing one-lung ventilation.

ONE-LUNG VENTILATION (OLV) traditionally has been provided with the use of a double-lumen tube (DLT). The use of bronchial blockers (BBs) to provide lung isolation has grown in recent years. Despite the development of BBs specifically designed for lung separation, the DLT has remained the preferred technique for providing lung isolation. A recent survey in the United Kingdom revealed a 98% preference rate for the DLT, 1 Shelley B. Macfie A. Kinsella J. Anesthesia for thoracic surgery: A survey of UK Practice. J Cardiothorac Vasc Anesth. 2011; 25: 1014-1017 Abstract Full Text Full Text PDF PubMed Scopus (64) Google Scholar and 64% of respondents reported rarely using a BB to provide lung isolation. A number of arguments have been advanced to support the notion that a DLT is superior to a BB and should be used routinely for providing OLV. In reality, some of these arguments are myths while others are valid, as will be presented in the discussion below. Double-Lumen Tubes for Tracheostomized PatientsJournal of Cardiothoracic and Vascular AnesthesiaVol. 29Issue 3PreviewWe thank Dr. Steven N. Neustein for his precise and concise article in the section, Pro and Con, entitled “Pro: Bronchial Blockers Should Be Used Routinely for Providing One-Lung Ventilation.”1 Full-Text PDF

Use of the 26-French Double-Lumen Tube for Lung Isolation in Children

Techniques for lung isolation in small children are limited to mainstem intubation and the use of bronchial blockers.1 Although the Marraro tube is a customized double-lumen tube for infants,2 the smallest commercially available double-lumen tube is 26 French (Rüsch Bronchopart®, Teleflex Medical, Athlone, Ireland). Reviews of pediatric lung isolation techniques recommend the 26-French double-lumen tube (26F DLT) for patients 8 to 10 years and older.3 However, there is only occasional mention of the actual use of the 26F DLT in the literature.

A Clinical Evaluation of the ProSeal Laryngeal Mask Airway With a Coopdech Bronchial Blocker for One-Lung Ventilation in Adults

To compare the effects of one-lung ventilation (OLV) offered by ProSeal laryngeal mask airway (PLMA) or endotracheal tube (ETT) with Coopdech bronchial blocker (BB) in adult patients undergoing thoracoscopic procedures, and also to evaluate the feasibility and security of application of PLMA with Coopdech BB for OLV. Prospective, randomized study. A local hospital. One-hundred adult patients undergoing thoracoscopic procedures. PLMA with Coopdech BB (group PLMA-BB, n=50) or ETT with Coopdech BB (group ETT-BB, n=50) was used for OLV. There were no differences between the groups in terms of time of OLV, time of correct placement of the BB, or cases of BB dislodgement. Forty-seven patients succeeded in OLV in the PLMA-BB group (94%), all patients succeeded in OLV in the ETT-BB group (100%), and there was no significant difference in success rate between groups (p>0.05). Arterial oxygen tension, end-expiration tidal volume, and peak airway pressure showed no statistical difference in TLV or 30 minutes after the initiation of OLV between 2 groups (p>0.05). The combined use of PLMA and Coopdech BB in adult patients can achieve adequate OLV for brief thoracoscopic procedures.

Reply to the Letter to the Editor on: Use of Bronchial Blockers for Single-Lung Ventilation in Infants and Children

Reply to the Letter to the Editor on: Use of Bronchial Blockers for Single-Lung Ventilation in Infants and Children

Use of Bronchial Blockers for Single-Lung Ventilation in Infants and Children

Use of Bronchial Blockers for Single-Lung Ventilation in Infants and Children

Use of bronchial blockers: a retrospective review of 302 cases

The purpose of this retrospective review is to evaluate the safety and efficacy of the bronchial blockers (BBs) used in thoracic anesthesia. We enrolled 302 patients who had a BB placed to achieve one-lung ventilation (OLV). Variables recorded from the anesthetic record included type of device used, type and side of surgery, specific indications for OLV, Mallampati score, route of intubation, and complications related to the use of BBs. The BBs used include the Arndt Wire-guided, Univent, Cohen Flexi-tip, Fogarty catheter, and Fuji. The majority of BBs placed were Arndt (n = 156) or Univent (n = 131). BBs were used significantly more often in thoracoscopic procedures than in thoracotomies (P < 0.01). Of the 251 patients, 216 (86%) had a Mallampati score of I/II and 35 (14%) had a score of III/IV. There were no identified complications related to BBs. In summary, BBs can be safely used to achieve OLV and offer advantages for OLV in specific situations.

Anaesthetic equipment for thoracic surgery

Thoracic surgery and anaesthesia increasingly require the use of selective one lung ventilation. This article reviews the use of double-lumen endobronchial tubes and bronchial blockers in this context. In the UK, the two most commonly used double-lumen endobronchial tubes are the Robertshaw (Phoenix Medical) and the Bronchocath (Mallinckrodt) tubes; these are described in some detail. Renewed interest is being shown in the use of bronchial blockade to achieve one lung ventilation, particularly with the increase in use of videoscopic surgical techniques. The use of bronchial blockers is briefly described along with potential advantages of their use, for example, in difficult intubation and when selective lobar blockade is required. Despite the increasing sophistication of endobronchial blockers and tubes there is considerable evidence that accurate placement can only be achieved with the use of fibreoptic bronchoscopy. This is also discussed.