scholarly journals Technical Aspects of Bronchopulmonary Lavage for Alveolar Proteinosis: Two Case Reports

1981 ◽  
Vol 9 (3) ◽  
pp. 277-285 ◽  
Author(s):  
G. A. Harrison ◽  
A. J. Kelly
Keyword(s):  
General Anaesthesia ◽  
Case Reports ◽  
Left Lung ◽  
Venous Admixture ◽  
Double Lumen ◽  
Technical Aspects ◽  
Lung Fluid ◽  
Alveolar Proteinosis ◽  
Double Lumen Endobronchial Tube ◽  
The Right

Under general anaesthesia, therapeutic bronchopulmonary lavage was performed in two patients suffering from alveolar proteinosis. In one patient, difficulties were experienced during attempted lavage of the right lung. Fluid trapping occurred when saline was infused down the tracheal (right) lumen of a Carlen's double lumen endobronchial tube and also when a left Robertshaw tube was similarly used. Spillover of saline into the left lung occurred when a right Robertshaw was used. Efficient lavage of the right lung could only be performed after insertion of a White endobronchial tube. In the second patient, both lungs were washed without problem using a left Robertshaw tube after difficulty had been experienced with a Carlen‘s tube. In both cases venous admixture was least when the lavaged lung was filled with saline. Hypoxaemia increased as the lung was drained. Details of technique are discussed as are problems with double lumen endobronchial tubes used during the procedure.

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.

scholarly journals Airway Management of the Right Anterior Segmentectomy through Uniportal Video-Assisted Thoracoscopic Surgery (VATS) after Left Pneumonectomy by An Adapted Double-lumen Endobronchial Tube (DLT): A Case Report

2019 ◽  
Author(s):  
Yang Gu ◽  
Ruowang Duan ◽  
Xin Lv ◽  
Jiong Song
Keyword(s):  
Thoracoscopic Surgery ◽  
Lung Resection ◽  
Perioperative Period ◽  
Radical Resection ◽  
Double Lumen ◽  
Intubation Technique ◽  
Video Assisted ◽  
Double Lumen Endobronchial Tube ◽  
The Right ◽  
Left Pneumonectomy

Abstract Background Lung resection after previous contralateral pneumonectomy is rare. We present a case of right anterior segmentectomy despite previous left pneumonectomy, demanding special ventilation strategy. Case presentation A 48-year-old woman was going to have the right anterior segmentectomy through uniportal video-assisted thoracoscopy (VATS) who had left pneumonectomy two years ago. A 32-French left-sided double-lumen endobronchial tube (DLT) was chosen and adapted. The DLT was intubated into the bronchus intermedius. And the upper lobe can be isolated from the ventilation in the middle and lower lobes when the bronchial cuff’s inflated. The perioperative period was uneventful and the pathological diagnosis was adenocarcinoma. Conclusion Lung cancer radical resection was discouraged after previous contralateral pneumonectomy partly due to the challenging ventilation and isolation. With this new DLT adapting and intubation technique showed in this case, the challenging ventilation and isolation that deter the promotion of the operation could be solved.

Update on Effectiveness of an Electromagnetic Feeding Tube–Placement Device in Detecting Respiratory Placements

2017 ◽  
Vol 26 (2) ◽  
pp. 157-161 ◽  
Author(s):  
Norma A. Metheny ◽  
Kathleen L. Meert
Keyword(s):  
Respiratory Tract ◽  
Case Reports ◽  
Left Lung ◽  
Feeding Tube ◽  
Brand Names ◽  
Tube Placement ◽  
Success Rates ◽  
User Facility ◽  
The Right ◽  
Feeding Tube Placement

Background Radiography is the accepted gold standard for testing feeding tube placement; however, an electromagnetic tube-placement device (ETPD) is sometimes used in lieu of radiography for this purpose. High success rates have been reported when the device was used by well-trained individuals. However, authors previously described 20 cases that occurred between 2007 and 2012 in which clinicians voluntarily reported inability to detect inadvertent tube insertions in the respiratory tract while using an ETPD. Objective To describe case reports to the US Food and Drug Administration’s Manufacturer and User Facility Device Experience (MAUDE) database between 2013 and 2015 regarding inadvertent respiratory placement of feeding tubes by operators using an ETPD. Methods The MAUDE database was searched for cases dated from January 1, 2013, through December 31, 2015, along with selected brand names. A total of 34 cases (25 after removal of duplicates) were located in which a feeding tube was inserted into the respiratory tract during insertions assisted by an ETPD. Results Sites of the malpositioned tubes included the right lung (n = 13), left lung (n = 6), unspecified lung (n = 4), and bronchus (n = 2). A pneumothorax occurred in 17 of the 25 misplacements; feedings were administered in 6 cases. Conclusions Many case reports involved clinicians failing to recognize tube misplacements in the respiratory tract while using an ETPD. These reports provide evidence that not all clinicians can use the device effectively to detect malpositioned tubes. Thus, one must continue to question the wisdom of eliminating radiographic confirmation of tube position before starting feedings.

scholarly journals Hypoxemia during One-lung Ventilation

2009 ◽  
Vol 110 (6) ◽  
pp. 1402-1411 ◽  
Author(s):  
Waheedullah Karzai ◽  
Konrad Schwarzkopf
Keyword(s):  
Left Lung ◽  
Lung Ventilation ◽  
Double Lumen Tube ◽  
Ventilation Strategy ◽  
One Lung Ventilation ◽  
Double Lumen ◽  
Lumen Tube ◽  
Alveolar Collapse ◽  
Lateral Decubitus ◽  
The Right

When switching from two-lung to one-lung ventilation (OLV), shunt fraction increases, oxygenation is impaired, and hypoxemia may occur. Hypoxemia during OLV may be predicted from measurements of lung function, distribution of perfusion between the lungs, whether the right or the left lung is ventilated, and whether the operation will be performed in the supine or in the lateral decubitus position. Hypoxemia during OLV may be prevented by applying a ventilation strategy that avoids alveolar collapse while minimally impairing perfusion of the dependent lung. Choice of anesthesia does not influence oxygenation during clinical OLV. Hypoxemia during OLV may be treated symptomatically by increasing inspired fraction of oxygen, by ventilating, or by using continuous positive airway pressure in the nonventilated lung. Hypoxemia during OLV may be treated causally by correcting the position of the double-lumen tube, clearing the main bronchi of the ventilated lung from secretions, and improving the ventilation strategy.

scholarly journals Airway Management of the Right Anterior Segmentectomy through Uniportal Video-Assisted Thoracoscopic Surgery (VATS) after Left Pneumonectomy by An Adapted Double-lumen Endobronchial Tube (DLT): A Case Report

2019 ◽  
Author(s):  
Yang Gu ◽  
Ruowang Duan ◽  
Jiong Song ◽  
Xin Lv
Keyword(s):  
Airway Management ◽  
Thoracoscopic Surgery ◽  
Lung Resection ◽  
Perioperative Period ◽  
Double Lumen ◽  
Intubation Technique ◽  
Video Assisted ◽  
Double Lumen Endobronchial Tube ◽  
The Right ◽  
Left Pneumonectomy

Abstract Background: Lung resection after previous contralateral pneumonectomy is rare. We present a case of right anterior segmentectomy despite previous left pneumonectomy, demanding special airway management strategy. Case presentation: A 48-year-old woman was going to have the right anterior segmentectomy through uniportal video-assisted thoracoscopy (VATS) who had left pneumonectomy two years ago. A 32-French left-sided double-lumen endobronchial tube (DLT) was chosen and adapted. The DLT was intubated into the bronchus intermedius. And the upper lobe can be isolated from the ventilation in the middle and lower lobes when the bronchial cuff’s inflated. The perioperative period was uneventful and the pathological diagnosis was adenocarcinoma. Conclusion: Lung cancer radical resection was discouraged after previous contralateral pneumonectomy partly due to the challenging ventilation and isolation. With this new DLT adapting and intubation technique showed in this case, the challenging ventilation and isolation that deter the promotion of the operation could be solved.

scholarly journals Airway Management of the Right Anterior Segmentectomy through Uniportal Video-Assisted Thoracoscopic Surgery (VATS) after Left Pneumonectomy by An Adapted Double-lumen Endobronchial Tube (DLT): A Case Report

2019 ◽  
Author(s):  
Yang Gu ◽  
Ruowang Duan ◽  
Jiong Song ◽  
Xin Lv
Keyword(s):  
Thoracoscopic Surgery ◽  
Lung Resection ◽  
Perioperative Period ◽  
Radical Resection ◽  
Double Lumen ◽  
Intubation Technique ◽  
Video Assisted ◽  
Double Lumen Endobronchial Tube ◽  
The Right ◽  
Left Pneumonectomy

Abstract Background Lung resection after previous contralateral pneumonectomy is rare. We present a case of right anterior segmentectomy despite previous left pneumonectomy, demanding special ventilation strategy. Case presentation A 48-year-old woman was going to have the right anterior segmentectomy through uniportal video-assisted thoracoscopy (VATS) who had left pneumonectomy two years ago. A 32-French left-sided double-lumen endobronchial tube (DLT) was chosen and adapted. The DLT was intubated into the bronchus intermedius. And the upper lobe can be isolated from the ventilation in the middle and lower lobes when the bronchial cuff’s inflated. The perioperative period was uneventful and the pathological diagnosis was adenocarcinoma. Conclusion Lung cancer radical resection was discouraged after previous contralateral pneumonectomy partly due to the challenging ventilation and isolation. With this new DLT adapting and intubation technique showed in this case, the challenging ventilation and isolation that deter the promotion of the operation could be solved.

Clinical Application and Results of the Assessment of Coronary Blood Flow by the Regional Precordial Xenon Residue Detection Technique

1978 ◽  
Vol 17 (04) ◽  
pp. 161-171
Author(s):  
H.-J. Engel ◽  
H. Hundeshagen ◽  
P. R. Lichtlen
Keyword(s):  
Wall Motion ◽  
High Flow ◽  
Detection Technique ◽  
Fatty Tissue ◽  
Technical Aspects ◽  
Residue Detection ◽  
High Affinity ◽  
Artery Disease ◽  
The Right ◽  
Drug Interventions

Methodological and technical aspects as well as application and results of the precordial Xenon-residue-detection technique are critically reviewed. The results concern mainly normal flow in various regions of the heart esp. in the free wall of the right and left ventricle, poststenotic flow in patients with coronary artery disease in relation to the degree of proximal nar-rowings as well as wall motion of the corresponding LV segment, bypassgraft flow and flow after drug interventions esp. nitrates, betablockers, the calcium-antagonist Nifedipine and the coronary dilator Dipyridamole. In spite of its serious limitations (high affinity of Xenon for fatty tissue, geometrical problems in the assessment of flow and its relation to anatomy, gas exchange in situations of high flow etc.), the technique is found to be a usefull investigatory tool. Due to its technical display and the related high costs routine application is, however, prohibitive.

CASE REPORT: SURGICAL MANAGEMENT OF LUMBAR COMPRESSION FRACTURE

2019 ◽  
Vol 1 (4) ◽  
Author(s):  
Yustinus Robby Budiman Gondowardojo ◽  
Tjokorda Gde Bagus Mahadewa
Keyword(s):  
Spinal Cord ◽  
Left Lung ◽  
Lumbar Vertebrae ◽  
Compression Fracture ◽  
High Mobility ◽  
Early Mobilization ◽  
Cord Injury ◽  
Cardiothoracic Surgeon ◽  
The Right

The lumbar vertebrae are the most common site for fracture incident because of its high mobility. The spinal cord injury usually happened as a result of a direct traumatic blow to the spine causing fractured and compressed spinal cord. A 38-year-old man presented with lumbar spine’s compression fracture at L2 level. In this patient, decompression laminectomy, stabilization, and fusion were done by posterior approach. The operation was successful, according to the X-Ray and patient’s early mobilization. Pneumothorax of the right lung and pleural effusion of the left lung occurred in this patient, so consultation was made to a cardiothoracic surgeon. Chest tube and WSD insertion were performed to treat the comorbidities. Although the patient had multiple trauma that threat a patient’s life, the management was done quickly, so the problems could be solved thus saving the patient’s life. After two months follow up, the patient could already walk and do daily activities independently.

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