Laryngeal mask combined with bronchial tube achieves one-lung ventilation for transthoracic oesophagectomy

2021 ◽  
Vol 14 (6) ◽  
pp. e240430
Author(s):  
Fang Kang ◽  
Juan Li ◽  
Gary Zhou
Keyword(s):  
Left Lung ◽  
Lung Ventilation ◽  
Bronchial Tube ◽  
Laryngeal Mask ◽  
Control Mode ◽  
Volume Control ◽  
Dependent Lung ◽  
One Lung Ventilation ◽  
Lung Isolation ◽  
Isolated Lung

Laryngeal mask combined with bronchial blocker provides an alternative for lung isolation but lacks adequate access to the non-dependent lung. Substituting the blocker with a bronchial tube may overcome this limitation. In this report, a #4.5 cuffed bronchial tube was introduced into the non-dependent lung through a second-generation laryngeal mask for transthoracic oesophagectomy. During the 2.5-hour thoracotomy, one-lung ventilation was achieved by isolating the left lung with the bronchial tube and ventilating the right lung via the laryngeal mask, using volume-control mode (7 mL/kg × 12/min) with PIP21–23 cm H2O, pH 7.36 and PaCO2 38.3. Prior to thoracotomy closure, suction and reinflation of the left lung were performed through the bronchial tube. Bronchoscopy via the laryngeal mask revealed no injury to the airway after removal of the bronchial tube. The case shows that laryngeal mask combined with bronchial intubation provides one-lung ventilation with access to the isolated lung.

scholarly journals A Randomized Controlled Trial Comparing Novel Triple-Cuffed Double-Lumen Endobronchial Tubes with Conventional Double-Lumen Endobronchial Tubes for Lung Isolation

2020 ◽  
Vol 9 (4) ◽  
pp. 977
Author(s):  
Namo Kim ◽  
Hyo-Jin Byon ◽  
Go Eun Kim ◽  
Chungon Park ◽  
Young Eun Joe ◽  
...  
Keyword(s):  
Controlled Trial ◽  
Fiberoptic Bronchoscopy ◽  
Lung Ventilation ◽  
One Lung Ventilation ◽  
Double Lumen ◽  
Lung Isolation ◽  
Significant Difference ◽  
Initial Placement ◽  
The Difference ◽  
Double Lumen Endobronchial Tube

Placing a double-lumen endobronchial tube (DLT) in an appropriate position to facilitate lung isolation is essential for thoracic procedures. The novel ANKOR DLT is a DLT developed with three cuffs with a newly added carinal cuff designed to prevent further advancement by being blocked by the carina when the cuff is inflated. In this prospective study, the direction and depth of initial placement of ANKOR DLT were compared with those of conventional DLT. Patients undergoing thoracic surgery (n = 190) with one-lung ventilation (OLV) were randomly allocated into either left-sided conventional DLT group (n = 95) or left-sided ANKOR DLT group (n = 95). The direction and depth of DLT position were compared via fiberoptic bronchoscopy (FOB) after endobronchial intubation between the groups. There was no significant difference in the number of right mainstem endobronchial intubations between the two groups (p = 0.468). The difference between the initial depth of DLT placement and the target depth confirmed by FOB was significantly lower in the ANKOR DLT group than in the conventional DLT group (1.8 ± 1.8 vs. 12.9 ± 9.7 mm; p < 0.001). In conclusion, the ANKOR DLT facilitated its initial positioning at the optimal depth compared to the conventional DLT.

scholarly journals A rare anaesthetic challenge in a one-lung ventilated paediatric patient with right upper lobe tracheal bronchus

2020 ◽  
Vol 48 (10) ◽  
pp. 030006052096760
Author(s):  
Yuangui Zhang ◽  
Meiman Qin ◽  
Xiaoqian Wang ◽  
Quanzhang Yan
Keyword(s):  
Paediatric Patient ◽  
Left Lung ◽  
Recurrent Infection ◽  
Lung Ventilation ◽  
Tracheal Bronchus ◽  
One Lung Ventilation ◽  
Recurrent Pneumonia ◽  
Single Lumen ◽  
History Of ◽  
The Right

A tracheal bronchus is a rare congenital anomaly, suggesting abnormal bronchial development. The prevalence of tracheal bronchus in children who undergo bronchoscopy is estimated to be between 0.2% and 3%. When associated with recurrent infection, lobes of the lung must be removed to avoid further lung injury. In such cases, perioperative one-lung ventilation and airway management remain a huge challenge for anaesthesiologists. The case of this rare airway anatomic abnormality in a paediatric patient with two bronchial openings into the right upper lobe, and with a history of recurrent pneumonia, is reported. In addition to a normal opening, a distinct opening in the upper lobe of the right lung was observed, that originated directly from the trachea, superior to the carina. The entire right lung was deflated by left-lung ventilation using a single lumen tracheal tube, and the patient underwent right upper lobe resection. No anaesthesia complications were observed during recovery. In this case, timely identification of the tracheal bronchus and successful collapse of the right lung were key points in the anaesthesia management of this patient.

scholarly journals Difficulty Intubating a Double-Lumen Tube due to a Tracheal Bronchus: A Case Report

2021 ◽  
Author(s):  
Wenzhu Wang ◽  
Ji Li ◽  
Jian Liu ◽  
Chengwei Song ◽  
ya-nan Zhang
Keyword(s):  
Left Lung ◽  
Lung Ventilation ◽  
Double Lumen Tube ◽  
Bronchial Blocker ◽  
Tracheal Bronchus ◽  
One Lung Ventilation ◽  
Double Lumen ◽  
Lumen Tube ◽  
The One ◽  
The Right

Abstract Background: Intubation difficulties, hypoxemia, inability to perform a one-lung ventilation, and high airway pressure often occur during double-lumen tube intubation. Tracheal bronchus is a very rare and difficult to find reason. We present a case of tracheal bronchus accidentally discovered during double-lumen tube intubation in a patient undergoing thoracic surgery. We are the first one to summarize the one-lung ventilation strategy for patients with tracheal bronchus. Case Presentation: A 53-year-old man underwent a scheduled thoracoscopic left upper lobectomy. After two unsuccessful attempts to pass the right-sided double-lumen tube through the right mainstem bronchus, fiberoptic bronchoscopy revealed an aberrant tracheal bronchus with an incidence of 0.1%–3%. Finally we used a left-sided DLT to ventilate the right lung. The patient had no airway complications and was discharged 7 days after the operation.Conclusions: This case serves to remind us that preoperative visits must be thorough and careful. Although a computed tomography chest examination was performed before surgery, we just looked at the inspection report and did not look at the images. We also reviewed relevant literature and summarized the one-lung ventilation strategies for patients with tracheal bronchus. For left-lung ventilation, either a left-sided double-lumen tube or a combination of a bronchial blocker and Fogarty artery embolization catheter can be used. For right-lung ventilation, a bronchial blocker or a left-sided double-lumen tube is a good choice.

Congenital Pulmonary Airway Malformation

2018 ◽  
Author(s):  
Alina Lazar
Keyword(s):  
Thoracic Surgery ◽  
Anesthetic Management ◽  
Lung Ventilation ◽  
Cardiovascular Complications ◽  
Positive Pressure ◽  
Clear Understanding ◽  
One Lung Ventilation ◽  
Lung Isolation ◽  
Isolation Techniques ◽  
Lung Abnormalities

Respiratory distress in infants may be caused by perinatal events and physiologic changes (e.g., lung immaturity, meconium aspiration, and persistent pulmonary hypertension); infectious processes; cardiovascular, neurologic, and metabolic abnormalities; as well as congenital lung abnormalities. Some of these may coexist, further complicating the diagnosis, clinical course, and management of the affected infant. Sound anesthetic management of congenital lung abnormalities requires a clear understanding of the pathophysiology of lung lesions and, in particular, the consequences of positive-pressure ventilation in patients with cystic and emphysematous lesions. Also critical is an appreciation for the physiologic differences in children undergoing thoracic surgery, indications for one-lung ventilation, age-appropriate lung isolation techniques, potential respiratory and cardiovascular complications that may occur during pediatric thoracic surgery, and the optimal choices for postoperative analgesia.

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

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.

Ventilatory Protective Strategies during Thoracic Surgery

2011 ◽  
Vol 114 (5) ◽  
pp. 1025-1035 ◽  
Author(s):  
Alf Kozian ◽  
Thomas Schilling ◽  
Hartmut Schütze ◽  
Mert Senturk ◽  
Thomas Hachenberg ◽  
...  
Keyword(s):  
Mechanical Stress ◽  
Lung Volume ◽  
Lung Ventilation ◽  
Alveolar Recruitment ◽  
Distribution Data ◽  
Dependent Lung ◽  
One Lung Ventilation ◽  
Lung Density ◽  
Computed Tomographic ◽  
Tidal Recruitment

Background The increased tidal volume (V(T)) applied to the ventilated lung during one-lung ventilation (OLV) enhances cyclic alveolar recruitment and mechanical stress. It is unknown whether alveolar recruitment maneuvers (ARMs) and reduced V(T) may influence tidal recruitment and lung density. Therefore, the effects of ARM and OLV with different V(T) on pulmonary gas/tissue distribution are examined. Methods Eight anesthetized piglets were mechanically ventilated (V(T) = 10 ml/kg). A defined ARM was applied to the whole lung (40 cm H(2)O for 10 s). Spiral computed tomographic lung scans were acquired before and after ARM. Thereafter, the lungs were separated with an endobronchial blocker. The pigs were randomized to receive OLV in the dependent lung with a V(T) of either 5 or 10 ml/kg. Computed tomography was repeated during and after OLV. The voxels were categorized by density intervals (i.e., atelectasis, poorly aerated, normally aerated, or overaerated). Tidal recruitment was defined as the addition of gas to collapsed lung regions. Results The dependent lung contained atelectatic (56 ± 10 ml), poorly aerated (183 ± 10 ml), and normally aerated (187 ± 29 ml) regions before ARM. After ARM, lung volume and aeration increased (426 ± 35 vs. 526 ± 69 ml). Respiratory compliance enhanced, and tidal recruitment decreased (95% vs. 79% of the whole end-expiratory lung volume). OLV with 10 ml/kg further increased aeration (atelectasis, 15 ± 2 ml; poorly aerated, 94 ± 24 ml; normally aerated, 580 ± 98 ml) and tidal recruitment (81% of the dependent lung). OLV with 5 ml/kg did not affect tidal recruitment or lung density distribution. (Data are given as mean ± SD.) Conclusions The ARM improves aeration and respiratory mechanics. In contrast to OLV with high V(T), OLV with reduced V(T) does not reinforce tidal recruitment, indicating decreased mechanical stress.

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