scholarly journals Pediatric Lung isolation in a limited resource setup: a case report

2019 ◽  
pp. e270
Author(s):  
Pankaj Baral ◽  
Jagat Narayan Prasad ◽  
Sabin Bhandari ◽  
Pratistha Thapa
Keyword(s):  
Endotracheal Tube ◽  
Lung Ventilation ◽  
Limited Resource ◽  
Lateral Position ◽  
Double Lumen Tube ◽  
Anesthesia Induction ◽  
Fiberoptic Bronchoscope ◽  
One Lung Ventilation ◽  
Lung Isolation ◽  
Left Lateral Position

Rationale: Pediatric lung isolation is a great challenge to an anesthesiologist. Despite various advances in techniques and equipment in lung isolation, most of the sophisticated devices are unavailable in remote setups. Blind techniques have been used, but they have a low success rate. Patient concerns: Here we report a case of a five year old male child who had cough and fever for one month. CT scan of chest revealed right sided empyema thoracis for which decortication was planned under general anaesthesia with one lung ventilation. Double lumen tube for this patient was not commercially available and we did not have a paediatric fiberoptic bronchoscope, which would fit inside the endotracheal tube necessary for the patient. Interventions: After anesthesia induction, an adult fiberoptic bronchoscope was used as an aid for insertion of bougie into the left mainstem bronchus followed by rail roading the endotracheal tube over the bougie for lung isolation. Outcomes: Surgery then proceeded in left lateral position with a right thoracotomy under a quiet surgical field. Conclusion: In case of unavailability of paediatric fiberoptic bronchoscope, an adult fiberoptic bronchoscope and a bougie can aid in successful lung isolation in paediatric patients.

scholarly journals Clinical Pearls in Anaesthesia for Pleurectomy/Decortication for Malignant Mesothelioma

2017 ◽  
Vol 11 (1) ◽  
pp. 29-34
Author(s):  
Shagun Bhatia Shah ◽  
Itee Chowdhury ◽  
Laleng Mawia Darlong ◽  
Priyanka Goyal ◽  
Anamica Kansal
Keyword(s):  
Malignant Mesothelioma ◽  
Lung Resection ◽  
Lung Ventilation ◽  
Double Lumen Tube ◽  
Visceral Pleura ◽  
One Lung Ventilation ◽  
Double Lumen ◽  
Lumen Tube ◽  
Lung Isolation ◽  
Lung Motion

Background: For most thoracic surgeries (lung resection, esophagectomy) the main purpose of inserting a double lumen tube for lung isolation is providing space for dissection and preventing lung motion by not ventilating (collapsing) the lung undergoing surgery. Objective: In addition, during pleurectomy/ decortication surgeries, the anaesthetist can indirectly perform the dissection of pleura from the lung without scrubbing, gloving or holding the scalpel. Conclusion: This is accomplished by ventilating the lung undergoing surgery, with large tidal volumes while the surgeon provides static traction to the visceral pleura. These phases alternate with one lung ventilation. A detailed account of anaesthesia for pleurectomy/ decortication follows.

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

Lung Isolation

2018 ◽  
Author(s):  
Bryan Hierlmeier ◽  
Vanetta Levesque ◽  
Henrique Vale
Keyword(s):  
Thoracoscopic Surgery ◽  
Hypoxic Pulmonary Vasoconstriction ◽  
Lung Ventilation ◽  
Double Lumen Tube ◽  
Lung Protective Ventilation ◽  
One Lung Ventilation ◽  
Double Lumen ◽  
Lung Isolation ◽  
Pulmonary Vasoconstriction ◽  
Protective Strategies

Lung isolation is being used more frequently in adult patients due to increasing incidence of thoracoscopy and video-assisted thoracoscopic surgery. There are several indications for lung isolation and one-lung ventilation (OLV) during surgery. Isolation is usually achieved by double-lumen endotracheal tubes or use of some type of bronchial blocker system. The initiation of OLV frequently leads to hypoxemia, the management of which should be stepwise. Additionally, clinical outcomes are significantly improved with the use of lung protective strategies during OLV. This review covers the use of few of the most common lung isolation devices, management of OLV using lung protective ventilation strategies, and management of oxygenation and hypoxemia during OLV. This review contains 12 figures, 6 tables, and 36 references. Key Words: bronchial blockers, double-lumen tube, uninvent, hypoxemia, hypoxic pulmonary vasoconstriction, one lung ventilation, positive end expiratory pressure, tracheal anatomy, lung isolation

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 Curved knife "Khukuri" injury in the back and anaesthesia induction in lateral position for thoracotomy

2010 ◽  
Vol 50 (180) ◽  
Author(s):  
A Subedi ◽  
M Tripathi ◽  
L Pathak ◽  
B Bhattarai ◽  
R Koirala
Keyword(s):  
Fiberoptic Bronchoscopy ◽  
Lung Ventilation ◽  
Lateral Position ◽  
Double Lumen Tube ◽  
Tube Placement ◽  
Thoracic Injury ◽  
One Lung Ventilation ◽  
Double Lumen ◽  
Lumen Tube ◽  
Induction Of Anaesthesia

Penetrating injury in the back with knife (Khukri) demands induction of anaesthesia and intubation in lateral position. In thoracic injury a double lumen tube placement is required to facilitate one lung ventilation during thoracotomy. In emerging situation, we could successfully execute induction of patient in right lateral position using right sided DLT for left thoracotomy. Its correct placement was confirmed by fiberoptic bronchoscopy. In conclusion right-DLT intubation can be performed without difficulty by conventional direct laryngoscopy using Macintosh blade in lateral position. Keywords: khukuri knife, lateral position, one lung ventilation, thoracic injury.

scholarly journals Sore Throat or Hoarse Voice with Bronchial Blockers or Double-Lumen Tubes for Lung Isolation: A Randomised, Prospective Trial

2008 ◽  
Vol 36 (6) ◽  
pp. 441-446
Author(s):  
T. Zhong ◽  
W. Wang ◽  
J. Chen ◽  
L. Ran ◽  
D. A. Story
Keyword(s):  
Sore Throat ◽  
Prospective Trial ◽  
Lung Ventilation ◽  
Double Lumen Tube ◽  
One Lung Ventilation ◽  
Double Lumen ◽  
Lumen Tube ◽  
Lung Isolation ◽  
Endobronchial Blocker ◽  
Hoarse Voice

Double-lumen endotracheal tubes and bronchial blockers allow lung isolation for one-lung ventilation. Few studies, however, directly compare these devices. Further, a new endobronchial blocker (Coopdech) is available in some countries. Our primary hypothesis was that bronchial blockers would be associated with less sore throat or hoarse voice than double-lumen tubes. Secondary outcomes were successful one-lung ventilation and surgical access. In this prospective trial, 120 Chinese patients undergoing elective surgery were randomly assigned to one of four groups of 30 patients: Coopdech blocker, Arndt blocker, Univent tube or double-lumen tube. Postoperative sore throat and hoarse voice were assessed in the recovery room and 24 hours after surgery. The incidence and severity of sore throat or hoarse voice was less in the blocker groups than double-lumen tube group: Coopdech 13%, Arndt 20%, Univent 30% and double-lumen tube 60%, P <0.001. The blocker groups did not significantly differ, P=0.28. Compared to the double-lumen tubes the bronchial blockers took about two minutes less to position but five minutes longer for lung deflation. Surgical exposure was uniformly good across the four groups. We conclude that clinical use of the Coopdech endobronchial blocker is similar to the Arndt and Univent blockers and that all three are associated with less sore throat or hoarse voice than double-lumen tubes.

scholarly journals The fraction of Nitrous Oxide in oxygen for facilitating Lung collapse During One-Lung Ventilation with double lumen tube

2020 ◽  
Author(s):  
chao liang ◽  
Yuechang Lv ◽  
Yu Shi ◽  
Jing Cang ◽  
Zhanggang Xue
Keyword(s):  
Nitrous Oxide ◽  
Confidence Interval ◽  
Thoracoscopic Surgery ◽  
Prospective Trial ◽  
Lung Ventilation ◽  
Effective Concentration ◽  
Double Lumen Tube ◽  
Test Results ◽  
Lung Collapse ◽  
One Lung Ventilation

Abstract Backgroud To the best of our knowledge, it is still unclear what is the proper fraction of nitrous oxide(N 2 O) in oxygen(O 2 ) for fast lung collapse. Therefore, we designed this prospective trial to determine the 50% effective concentration (EC 50 ) and 95% effective concentration (EC 95 ) of N 2 O in O 2 for fast lung collapse. Methods We studied 38 consecutive patients undergoing video-assisted thoracoscopic surgery(VATS). The lung collapse score(LCS) of each patient during one lung ventilation was evaluated by the same surgeon. The first patient received 30% N 2 O in O 2 , and subsequent N 2 O fraction in O 2 was determined by the LCS of previous patient using Dixon up-and-down method. The testing interval was set at 10%, and the lowest concentration was 10% (10%, 20%, 30%, 40%, or 50%). The EC 50 and EC 95 of N 2 O in O 2 for fast lung collapse were analyzed using probit test. Results The N 2 O fraction in O 2 at which all patients showed success lung collapse was 50%, according to the up-and-down method. The EC 50 and EC 95 of N 2 O in O 2 for fast lung collapse were 27.7% (95% confidence interval, 19.9%–35.7%) and 48.7% (95% confidence interval, 39.0%–96.3%), respectively. Conclusions In patients undergoing VATS, the EC 50 and EC 95 of N 2 O in O 2 for fast lung collapse were 27.7% and 48.7%, respectively.

scholarly journals One lung ventilation in thoracic esophageal operation: Clinical experience using endotracheal tube with movable blocker.

1985 ◽  
Vol 18 (7) ◽  
pp. 1595-1599 ◽  
Author(s):  
Takashi SUGIHARA ◽  
Hiroyasu MAKUUCHI ◽  
Tetsuji SASAKI ◽  
Tomoo TAJIMA ◽  
Toshio MITOMI ◽  
...  
Keyword(s):  
Endotracheal Tube ◽  
Clinical Experience ◽  
Lung Ventilation ◽  
One Lung Ventilation
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