Adapter to convert single-lumen endotracheal tube to endobronchial blocker for one-lung anesthesia

Lung separation techniques in the morbidly obese patient undergoing thoracic or esophageal surgery may be at risk of complications during airway management. Access to the airway in the obese patient can be a challenge because they have altered airway anatomy, including a short and redundant neck, limited neck extension and accumulation of fat deposition in the pharyngeal wall contributing to difficult laryngoscopy. Securing the airway is the first priority in these patients followed by appropriate techniques for lung separation with the use of a single-lumen endotracheal tube and a bronchial blocker or another alternative is with the use of a double-lumen endotracheal tube. This review is focused on the use of lung isolation devices in the obese patient. The recommendations are based upon scientific evidence, case reports or personal experience. Fiberoptic bronchoscopy must be used to place and confirm proper placement of a single-lumen endotracheal tube, bronchial blocker or double-lumen endotracheal tube.

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Provision of stable lung isolation in an unstable patient: an endobronchial blocker through the Murphy eye of the in situ endotracheal tube

Journal of Anesthesia ◽

10.1007/s00540-011-1116-5 ◽

2011 ◽

Vol 25 (3) ◽

pp. 454-456

Author(s):

Anthony M.-H. Ho ◽

Innes Y. P. Wan ◽

Randolph H. L. Wong ◽

Calvin S. H. Ng ◽

Siu K. Ng

Keyword(s):

Endotracheal Tube ◽

Lung Isolation ◽

Unstable Patient ◽

Endobronchial Blocker

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The Effects of Anesthesiologist Experience on Postoperative Hoarseness After Double-Lumen Endotracheal Tube Intubation: A Single-Center Propensity Score-Matched Analysis

10.21203/rs.3.rs-41784/v1 ◽

2020 ◽

Author(s):

Yuji Kamimura ◽

Toshiyuki Nakanishi ◽

Aiji Sato(Boku) ◽

Satoshi Osaga ◽

Eisuke Kako ◽

...

Keyword(s):

Propensity Score ◽

Endotracheal Tube ◽

Propensity Score Matching ◽

Lung Resection ◽

Macintosh Laryngoscope ◽

University Hospital ◽

Double Lumen ◽

Double Lumen Endotracheal Tube ◽

Single Lumen ◽

One To One

Abstract Background: Postoperative hoarseness after general anesthesia is associated with patient discomfort and dissatisfaction. A recent large retrospective study showed that single-lumen endotracheal tube intubation by a trainee did not alter the incidence of postoperative pharyngeal symptoms compared with that by a senior anesthesiologist. However, little is known about the relationship between anesthesiologist experience and hoarseness after double-lumen endotracheal tube intubation. We tested the hypothesis that double-lumen endotracheal tube intubation by a trainee increases the incidence of postoperative hoarseness compared with that by a senior anesthesiologist.Methods: This retrospective observational study included patients who underwent lung resection from April 2015 to March 2018 in a university hospital. Patients underwent double-lumen endotracheal tube intubation with a Macintosh laryngoscope. We divided the patients into two groups: one group comprising patients whose tracheas were intubated by a trainee anesthesiologist and the other comprising those whose tracheas were intubated by a senior anesthesiologist. The primary outcome was the incidence of postoperative hoarseness 24 h after surgery. We collected data on postoperative hoarseness using a checklist of postanesthetic adverse events. One-to-one propensity score matching was performed. P values of <0.05 were considered statistically significant.Results: There were 256 eligible patients; 153 patients underwent intubation by trainee anesthesiologists, and the remaining 103 patients underwent intubation by senior anesthesiologists. The one-to-one propensity score matching generated 96 pairs of patients for the groups. The incidence of postoperative hoarseness 24 h after the surgery was significantly higher in patients whose tracheas were intubated by a trainee anesthesiologist than in those whose tracheas were intubated by a senior anesthesiologist (9.4% vs. 2.1%, respectively; P = 0.03).Conclusions: Double-lumen endotracheal tube intubation by trainee anesthesiologists increased the incidence of postoperative hoarseness 24 h after the surgery compared with intubation by senior anesthesiologists.

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Successful one-lung ventilation by blocking the right intermediate bronchus in a 7-year-old child: a case report

Journal of International Medical Research ◽

10.1177/0300060519845782 ◽

2019 ◽

Vol 47 (6) ◽

pp. 2740-2745

Author(s):

Seung Youp Baek ◽

Jin Hwan Kim ◽

Goo Kim ◽

Jin Ho Choi ◽

Chang Young Jeong ◽

...

Keyword(s):

Endotracheal Tube ◽

Main Bronchus ◽

Left Lung ◽

Lung Ventilation ◽

Surgical Excision ◽

One Lung Ventilation ◽

Lower Lung ◽

Endobronchial Blocker ◽

Surgical Field ◽

The Right

A 7-year-old child underwent surgical excision of a benign mesothelioma of the pleura near the right lower lung. Although insertion of a wire-reinforced endotracheal tube through the left main bronchus was attempted for one-lung ventilation to secure the surgical field of view, the attempt failed. Therefore, an endotracheal tube was inserted into the trachea, and an Arndt endobronchial blocker (Cook Medical, Bloomington, IN, USA) was placed in the right intermediate bronchus under bronchoscopic guidance to selectively block the right lower and middle lobes. The surgery was performed while ventilating the right upper lobe and left lung, and no specific intraoperative adverse events occurred.

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