Thoracic anaesthesia

2014 ◽  
Author(s):  
Jeremy Prout ◽  
Tanya Jones ◽  
Daniel Martin
Keyword(s):  
Thoracic Surgery ◽  
Surgical Procedures ◽  
Lung Ventilation ◽  
Chest Drain ◽  
One Lung Ventilation ◽  
Double Lumen ◽  
Thoracic Surgical Procedures ◽  
Hypoxic Vasoconstriction ◽  
Thoracic Anaesthesia ◽  
Drain Management

Pre-assessment of patients for thoracic surgery with prediction of postoperative dyspnoea is important and may determine ‘operability’ of malignancy. Anaesthetic conduct for common thoracic surgical procedures such as thoracotomy, video-assisted thorascopic surgery, mediastinal surgery, and bronchoscopic techniques are described. Techniques for providing one-lung ventilation using double-lumen tubes or endobronchial blockers are discussed along with the physiology of one-lung ventilation, hypoxic vasoconstriction, and techniques to improve oxygenation. Thoracic postoperative care such as pain and chest drain management is included

Face-To-Face Double-Lumen Tube Intubation With the Airtraq Video Laryngoscope for Emergency Thoracic Surgery: A Case Report

2021 ◽  
pp. 108925322110076
Author(s):  
Yacine Ynineb ◽  
Emilie Boglietto ◽  
Francis Bonnet ◽  
Christophe Quesnel ◽  
Marc Garnier
Keyword(s):  
Thoracic Surgery ◽  
Bronchopleural Fistula ◽  
Rapid Sequence Induction ◽  
Lung Ventilation ◽  
Double Lumen Tube ◽  
One Lung Ventilation ◽  
Double Lumen ◽  
Lumen Tube ◽  
Face To Face ◽  
High Flow Oxygen

Double-lumen intubation is commonly used for thoracic surgery as it allows rapid and effective one-lung ventilation. However, it is more difficult than single-lumen tube intubation, notably in the context of emergency surgery and/or in hypoxemic patients. We report the case of a 57-year-old patient requiring emergency revision surgery after an upper right lobectomy due to postoperative pneumothorax and pleuropneumonia. As rapid lung isolation was required due to a bronchopleural fistula, rapid sequence induction and double-lumen tube intubation were performed. In addition, as the patient was hypoxemic with incomplete pre-oxygenation and too uncomfortable to tolerate the recumbent position despite high-flow oxygen, intubation was performed in face-to-face position. The patient was successfully intubated in 22 seconds and the right lung immediately isolated, allowing the surgeon to clean the pleural cavity. This is the first report of a double-lumen tube intubation in face-to-face position. The expected difficulties related to this type of intubation were successfully prevented using an Airtraq laryngoscope. Although such a strategy cannot be recommended from this one case, this report is encouraging for future studies evaluating the potential advantages of Airtraq use for double-lumen face-to-face intubation for emergency thoracic surgery.

scholarly journals Robertshaw Double Lumen Tubes: A Reappraisal Thirty Years On

1994 ◽  
Vol 22 (2) ◽  
pp. 179-183 ◽  
Author(s):  
I. D. Conacher ◽  
I. H. Herrema ◽  
A. M. Batchelor
Keyword(s):  
Thoracic Surgery ◽  
Clinical Assessment ◽  
Clinical Guidelines ◽  
Lung Ventilation ◽  
Fibreoptic Bronchoscopy ◽  
One Lung Ventilation ◽  
Double Lumen ◽  
Tube Position ◽  
Common Problems ◽  
Training Of Personnel

A propsective analysis of 100 successive intubations with Robertshaw tubes in patients submitted for routine thoracic surgery is presented. Clinical guidelines for intubation were used as the protocol. Tube position was judged on clinical assessment only and not confirmed with fibreoptic bronchoscopy. In approximately 60% of cases the tubes were judged to be correctly placed on initial introduction. In 20-30% of cases, minor and simple adjustments were required to achieve suitable conditions for one lung anaesthesia. In no case did it prove impossible to achieve conditions adequate for surgery. Common problems related to the endobronchial portion of tubes entering the wrong bronchus, being inserted too far, or not far enough. Two of six episodes of hypoxaemia related to minor problems with tubes and were easily corrected. The experience is compared with that of other workers. The pertinence and implications of the experience and the data to the training of personnel in the techniques of one-lung ventilation and the future of Robertshaw tubes are discussed. It is concluded that the good practical results achieved are specifically related to the Robertshaw design and the material of manufacture.

The “Spacemaker”, a New Device for Minimally Invasive Cardiothoracic Surgery: An Evaluation and Feasibility Study

2015 ◽  
Vol 10 (4) ◽  
pp. 241-247
Author(s):  
Pieter W.J. Lozekoot ◽  
Sandro Gelsomino ◽  
Paul B. Kwant ◽  
Orlando Parise ◽  
Francesco Matteucci ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Surgical Procedures ◽  
Lung Tissue ◽  
Lung Ventilation ◽  
Cardiothoracic Surgery ◽  
Respiratory Compromise ◽  
One Lung Ventilation ◽  
New Device ◽  
Lead Placement ◽  
The Right

Objective Our aim was to evaluate a new inflatable lung retractor, the “Spacemaker”, and its efficacy in facilitating minimally invasive cardiothoracic surgery without the need of one lung ventilation or carbon dioxide overpressure insufflation. Methods The device was tested in 12 anesthetized pigs (90–100 kg) placed on standard endotracheal ventilation. The device was introduced into the right or left side of the chest, depending on the intended procedure to be performed, via a 3-cm incision in the fifth intercostal space. A total of seven animals were used to evaluate hemodynamic and respiratory response to the device, whereas another five animals were used to assess the feasibility of a variety of minimally invasive cardiothoracic surgical procedures. Results Introduction was easy and unhindered. The device was inflated up to 0.6 bar, thereby pushing the lung tissue gently away cranially, posteriorly, and caudally without interfering with pulmonary function or resulting in respiratory compromise. In addition, hemodynamics remained stable throughout the experiments. Different closed-chest surgical procedures such as left atrial appendage exclusion, pulmonary vein exposure, pacemaker lead placement, and endoscopic stabilization for coronary surgery, were successfully performed. Removal was quick and complete in all cases, and lung tissue showed no remnant atelectasis. Conclusions The “Spacemaker” may represent a reliable alternative to current conventional techniques to facilitate minimally invasive cardiothoracic surgery. Further research is warranted to confirm the effectiveness and the safety of this device and to optimize the model before its use in humans and its introduction into clinical practice.

Sign in / Sign up

Export Citation Format

Share Document