Articles: bronchial-blocker.
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J. Cardiothorac. Vasc. Anesth. · Feb 2019
Lung Isolation Techniques in Patients With Early-Stage or Long-Term Tracheostomy: A Case Series Report of 70 Cases and Recommendations.
Lung isolation techniques are designed to facilitate surgical exposure in thoracic surgical patients and provide one-lung ventilation (OLV). Some patients have a tracheostomy in situ, which makes the management of the airway and OLV difficult. The objective of this retrospective study was to review cases that had a tracheostomy prior to thoracic surgery and evaluate the clinical use and efficiency with the airway management and lung isolation devices. ⋯ In patients undergoing thoracic surgery and OLV, and with a fresh tracheostomy stoma in situ, the authors recommend the use of the Shiley tracheostomy tube plus a bronchial blocker. In patients with a long-term tracheostomy stoma, a SLT can be used selectively to intubate 1 bronchus. In addition, an SLT or a Shiley tube can be used in conjunction with an independent bronchial blocker, such as the Arndt wire-guided bronchial blocker, Cohen tip-deflecting blocker, Fuji Uniblocker, or EZ-Blocker. DLTs are the least frequently used device for OLV in tracheostomized patients.
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Video-assisted transthoracic surgery (VATS) is a minimally invasive procedure that has been reported as a valid method for tracheal resection and reconstruction. However, for patients with tracheal tumors, one-lung ventilation during VATS is difficult to achieve, and utilizing a double-lumen tube is not applicable in these types of situations. When using a bronchial blocker, a fiberoptic bronchoscope is required to verify the position of bronchial blocker, though the repeated use of the fiberoptic bronchoscope increases the risk of tumor rupture and hemorrhage. ⋯ VivaSight™ single-lumen tube combined with a bronchial blocker is a feasible choice for one-lung ventilation in this type of surgery.
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Paediatric anaesthesia · Nov 2018
Anesthetic management of thoracoscopic resection of lung lesions in small children.
Video-assisted thoracoscopic surgery has dramatically increased over the last decade because of both medical and cosmetic benefits. Anesthesia for video-assisted thoracoscopic surgery in small children is more challenging compared to adults due to the considerable problems posed by small airway dimensions and ventilation. The optimal technique for one-lung ventilation has yet to be established and the use of remifentanil infusion in this setting is not well described. ⋯ One-lung ventilation with an extraluminal parallel blocker was used effectively in this series of young children undergoing thoracoscopic excision of congenital pulmonary lesions. Remifentanil infusion attenuated surgical stress effectively in infants and small children undergoing video-assisted thoracoscopic surgery.
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One of the main tasks in every anesthetist's routine clinical practice is securing the airway. This also includes techniques for lung isolation and one-lung ventilation in thoracic surgery and in intensive care medicine. The anesthesiologist has various methods available to achieve one-lung ventilation. ⋯ These include the double lumen tube, the bronchus blockers by Arndt and Cohen, the EZ blocker, the Uniblocker, the Univent tube and the VivaSight-DL™. The effects of the one-lung ventilation are not described in detail and for this the reader should refer to the appropriate literature. This article is intended to provide an overview of the various possibilities for lung separation, especially for physicians in continued medical education and also for physicians who rarely use these procedures.