The ventilation parameters during the Nuss procedure for repair of pectus excavatum

2020 ◽  
Vol 26 (2-3) ◽  
pp. 28-37
Author(s):  
I.I. Myhal ◽  
◽  
U.A. Fesenko ◽  
A.O. Dvorakevich ◽  
A.A. Albokrinov ◽  
...  
Keyword(s):  
Pectus Excavatum ◽  
Double Lumen Tube ◽  
Nuss Procedure ◽  
Airway Protection ◽  
Point Scale ◽  
Double Lumen ◽  
Lumen Tube ◽  
Single Lumen ◽  
Group D

The ventilation parameters during the Nuss procedure for repair of pectus excavatum depend on surgical procedures and airway protection technique. The aim of the study: analyzing the ventilation parameters during the Nuss procedure for repair of pectus excavatum according to the airway protection technique. Material and Methods. The observational prospective study included 60 adolescents (boys/girls=47/13) who had undergone the Nuss procedure for repair of pectus excavatum under a combination of general anesthesia with different types of regional blocks. The patients were randomized into two groups (n=20 in each) according to the airway protection technique: Group S (n=32) where the patients were intubated with a standard single-lumen tube, and capnothorax with 4-6 mmHg intrapleural pressure was applied; Group D (n=28) where the patients were intubated with a double-lumen tube, and open pneumothorax was applied without additional pressure in the thoracic cavity. All patients were ventilated using PCV with changing of the parameters in relevance with EtCO2. The following parameters were analyzed: peripheral blood saturation (SpO2), inspiratory fractional oxygen concentration (FiO2), end-tidal carbon dioxide partial pressure (EtCO2), tidal volume (Tv), peak inspiratory pressure (PIP), positive end-expiratory pressure (PEEP), the number of repeated intubation attempts, and the quality of operation field visualization checked by surgeon with a 5-point scale. Results and Discussion. During capno/pneumothorax and bar rotation, in both groups SpO2 decreased up to 95%, which required increasing FiO2 up to 70% in Group D, and up to 63% in Group S (р=0.04). Applying capno/pneumothorax lead to reduced Tv, which was 52 ml less in Group D than in Group S (р=0.0001). The levels of EtCO2, PIP, and PEEP were comparable in both groups at all stages of the surgery. The number of repeated intubation attempts was- 1 case (3,1%) in group S, and 2 cases (7,1%) in group D: c2 = 0,51; p=0.48, the adjusted c22 = 3.84 for p <0.05. The quality of operation field visualization evaluated by the surgeons with the 5-point scale was better in Group D (4.5 points), than in Group S - 3 points (р<0.000001) at all stages. Conclusions. The one-lung ventilation using double-lumen left-side tube provides better operating field visualization than ventilation throw single-lumen tube with capnothorax. Both techniques supply adequate ventilation and oxygenation parameters. Key words: tracheal intubation, ventilation, pectus excavatum, Nuss procedure

The Comparative Study of the Single-lumen Tube and Double-lumen Tube in the Blood Gas Analysis for One-lung Ventilation

1994 ◽  
Vol 27 (4) ◽  
pp. 381
Author(s):  
Su Won Kim ◽  
Byung Young Kim ◽  
Myoung Hoon Kong ◽  
Hae Ja Lim ◽  
Byung Kook Chae ◽  
...  
Keyword(s):  
Lung Ventilation ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Double Lumen Tube ◽  
Blood Gas ◽  
One Lung Ventilation ◽  
Double Lumen ◽  
Lumen Tube ◽  
Single Lumen ◽  
The Comparative Study

scholarly journals ANAESTHETIC MANAGEMENT OF BRONCHOGENIC CYST IN AN INFANT:- A CHALLENGE- A CASE REPORT

2019 ◽  
pp. 1-2
Author(s):  
Garima Anant ◽  
Aman Kaur Saini
Keyword(s):  
Bronchogenic Cyst ◽  
Lung Ventilation ◽  
Female Child ◽  
Anaesthetic Management ◽  
Double Lumen Tube ◽  
One Lung Ventilation ◽  
Double Lumen ◽  
Lumen Tube ◽  
Lung Isolation ◽  
Single Lumen

A double-lumen tube is an endotracheal tube designed to isolate the lungs anatomically and physiologically. Double-lumen tubes are the most commonly used tubes to provide independent ventilation for each lung. One-lung ventilation or lung isolation is the mechanical and functional separation of the 2 lungs to allow selective ventilation of only one lung. The other lung that is not being ventilated passively deates or is displaced by the surgeon to facilitate surgical exposure for non-cardiac operations in the chest such as thoracic, esophageal, aortic and spine procedures. But due to the larger size and more complex design than the single lumen tube (SLT), intubation with a DLT can be a challenge, especially in paediatric patients. We present a case of 2.5 month female child, weighing 3 kgs , diagnosed antenatally by ultrasound with bronchogenic cyst .Left thoracotomy with excision of cyst was the planned surgery for the patient

scholarly journals Use of a Fogarty Catheter as a Bronchial Blocker through a Single-lumen Endotracheal Tube in Patients with Subglottic Stenosis

2003 ◽  
Vol 31 (2) ◽  
pp. 214-216 ◽  
Author(s):  
H. P. Park ◽  
J. H. Bahk ◽  
J. H. Park ◽  
Y. S. Oh
Keyword(s):  
Endotracheal Tube ◽  
Lung Ventilation ◽  
Subglottic Stenosis ◽  
Double Lumen Tube ◽  
Bronchial Blocker ◽  
Fogarty Catheter ◽  
One Lung Ventilation ◽  
Double Lumen ◽  
Lumen Tube ◽  
Single Lumen

One-lung ventilation can be achieved with a double-lumen tube or a bronchial blocker. However, the larger outer diameters of double-lumen or Univent tubes may prevent their passage through an area of subglottic stenosiss. We present five cases of subglottic stenosis in which a Fogarty catheter was used as a bronchial blocker through a single-lumen endotracheal tube. The outer diameters of a double-lumen tube, Univent tube and single-lumen tube were compared. Despite special equipment designed for one-lung ventilation, the use of a bronchial blocker through a single-lumen tube, which has the thinnest available wall thickness, seems to be one of the most effective and safest ways of achieving one-lung ventilation in patients with subglottic stenosis or narrowing.

scholarly journals Effect-site concentration of remifentanil required to blunt haemodynamic responses during tracheal intubation: A randomized comparison between single- and double-lumen tubes

2017 ◽  
Vol 46 (1) ◽  
pp. 430-439
Author(s):  
Tae Kyong Kim ◽  
Deok Man Hong ◽  
Seo Hee Lee ◽  
Hyesun Paik ◽  
Se Hee Min ◽  
...  
Keyword(s):  
Tracheal Intubation ◽  
Lung Ventilation ◽  
Double Lumen Tube ◽  
One Lung Ventilation ◽  
Double Lumen ◽  
Lumen Tube ◽  
Effect Site ◽  
Target Controlled Infusion ◽  
Single Lumen ◽  
Effect Site Concentration

Objective To investigate the effect-site concentration of remifentanil required to blunt haemodynamic responses during tracheal intubation with a single-lumen tube (SLT) or a double-lumen tube (DLT). Methods Patients scheduled for thoracic surgery requiring one-lung ventilation were randomly allocated to either the SLT or DLT group. All patients received a target-controlled infusion of propofol and a predetermined concentration of remifentanil. Haemodynamic parameters during intubation were recorded. The effect-site concentration of remifentanil was determined using a delayed up-and-down sequential allocation method. Results A total of 92 patients were enrolled in the study. The effective effect-site concentrations of remifentanil required to blunt haemodynamic responses in 50% of patients (EC50) estimated by isotonic regression with bootstrapping was higher in the DLT than the SLT group (8.5 ng/ml [95% confidence interval (CI) 8.0–9.5 ng/ml] versus 6.5 ng/ml [95% CI 5.6–6.7 ng/ml], respectively). Similarly, the effective effect-site concentrations of remifentanil in 95% of patients in the DLT group was higher than the SLT group (9.9 ng/ml [95% CI 9.8–10.0 ng/ml] versus 7.0 ng/ml [95% CI 6.9–7.0 ng/ml], respectively). Conclusions This study demonstrated that a DLT requires a 30% higher EC50 of remifentanil than does an SLT to blunt haemodynamic responses during tracheal intubation when combined with a target-controlled infusion of propofol. Trial registration Clinicaltrials.gov identifier: NCT01542099.

scholarly journals Comparison of Double-Lumen Tube and EZ-Blocker for Lung Separation in Thoracic Surgery - A Randomised Controlled Clinical Trial

2021 ◽  
Author(s):  
Joachim Risse ◽  
Karsten Szeder ◽  
Ann-Kristin Schubert ◽  
Thomas Wiesmann ◽  
Hanns-Christian Dinges ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Double Lumen Tube ◽  
Lung Collapse ◽  
Double Lumen ◽  
Lumen Tube ◽  
Trial Register ◽  
German Clinical Trial Register ◽  
Randomised Controlled ◽  
Clinical Trial Register

Abstract Background:Double lumen tube (DLT) intubation is the most commonly used technique for lung separation. Bronchial blockers (BB) are an alternative, especially for difficult airways. The EZ-bronchial blocker (EZB) is the newest device of the BB family. Methods:A randomised, controlled trial was conducted in 80 patients undergoing elective thoracic surgery using DLT or SLT plus EZB for lung separation (German Clinical Trial Register DRKS00014816). The objective of the study was to compare the clinical performance of EZB with DLT. Primary endpoint was total time to successful lung separation. Secondary endpoints were time subsections, quality of lung collapse, difficulty of intubation, any complications during the procedure, incidence of objective trauma of the oropharynx and supraglottic space and intubation-related subjective symptoms.Results:74 patients were included, DLT group (n = 38), EZB group (n = 36). Median total time for lung separation [IQR] in DLT group was 234 seconds [207 to 294] versus 298 seconds [243 to 369] in EZB group (P=0.007). Quality of lung collapse was equal in both groups, DLT group 89.5% were excellent vs. 83.3 % in the EZB group (P=0.444). Inadequate lung collapse in five patients of the EZB group resulted in unsuccessful repositioning attempts and secondary DLT placement. Endoscopic examinations revealed significantly more carina trauma (P=0.047) and subglottic haemorrhage (P=0.047) in the DLT group. Additionally, postoperative subjective symptoms (sore throat, hoarseness) were more common in the DLT group, as were speech problems.Conclusions:Using the EZB results in prolonged lung separation compared to DLT, prima facie with equal quality of lung collapse for the thoracic surgeon. Five crossover cases demonstrated the superiority of the use of left-sided DLT especially in the indication for EZB for a right open thoracotomy or right video-assisted thoracoscopic surgery (VATS). Using the EZB showed only little evidence for reducing objective airway trauma e.g. less carina trauma as well as subjective complaints.Trial registration:German Clinical Trial Register DRKS00014816, prospectively registered on 07.06.2018https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00014816

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