Use of the Arndt wire-guided endobronchial blocker via nasal for one-lung ventilation in patient with anticipated restricted mouth opening for esophagectomy.

Department of Anesthesia, Chang Gung Memorial Hospital, 5, Fu-shin Street, Kweishan, Taoyuan 333, Taiwan, ROC.
European Journal of Cardio-Thoracic Surgery (Impact Factor: 2.81). 08/2005; 28(1):174-5. DOI: 10.1016/j.ejcts.2005.03.013
Source: PubMed

ABSTRACT Functional separation of the lungs may be accomplished by several methods. Patient with restricted mouth opening has limited options for one-lung ventilation. We report the use of wire-guided endobronchial blockade, a new tool for achieving one-lung ventilation in a patient with restricted mouth opening requiring nasotracheal, fiberoptic intubation for esophagectomy and reconstruction with gastric tube substitution.

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    ABSTRACT: Recent advances in surgical techniques for thoracic, cardiac, and oesophageal surgery have led to an increased use of lung separation techniques. Currently, double-lumen endotracheal tubes (DLT) and bronchial blockers (an Arndt wire-guided endobronchial blocker, a Cohen Flexitip endobronchial blocker, or the Fuji Uniblocker) are used. 1-3 Achieving successful lung separation relies on knowledge of the anatomical distances of the airway, flexible fibreoptic bronchoscopy techniques, and familiarity with left and right-sided DLTs and bronchial blockers. In general, lung isolation techniques are designed to: facilitate surgical exposure for cases involving the thoracic cavity, to prevent contamination of the contralateral lung in cases where pus or haemorrhage is present, and to establish airway continuity such as in a patient who presents with bronchopleural fistula and requires mechanical ventilation. Specific indications with bronchial blockers include: patients with difficult airways, patients with tracheostomy that require lung separation, selective lobar blockade, or whenever postoperative mechanical ventilation is contemplated. This review focuses on the current methods used to achieve lung separation. The objectives include: selecting the proper size device, intubation issues, optimal positioning with the use of a flexible fibreoptic bronchoscope, potential complications, and the management of lung isolation devices and what to do when they do not work.
    08/2014; 14(1). DOI:10.1080/22201173.2008.10872517
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    ABSTRACT: This review is a clinical comparison between double-lumen endotracheal tubes and bronchial blockers to determine which device is considered the best for lung isolation. Double-lumen endotracheal tubes and bronchial blockers have been found to be clinically equivalent in terms of performance in providing lung collapse for patients with normal airways. In the last five years, however, numerous reports have indicated a preference for the use of bronchial blockers in patients with airway abnormalities. For nonthoracic anesthesiologists who have limited experience in thoracic anesthesia cases, none of the devices (double-lumen tubes or bronchial blockers) have been shown to provide any advantage while in use due to a high incidence of unrecognized malpositions. Overall, each device provides advantages depending upon the case, such as absolute lung separation with a double-lumen endotracheal tube or the use of a bronchial blocker in a difficult airway for a patient requiring lung isolation. Double-lumen endotracheal tubes and bronchial blockers should be part of the armamentarium of every anesthesiologist involved in lung isolation techniques and every device should be tailored to specific case needs.
    Current Opinion in Anaesthesiology 03/2007; 20(1):27-31. DOI:10.1097/ACO.0b013e3280111e2a · 2.53 Impact Factor
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    ABSTRACT: One-lung ventilation in the thoracic surgical patient can be achieved with the use of a double-lumen endotracheal tube or an independent bronchial blocker. A number of patients requiring lung isolation have a potentially difficult airway because of previous radiation to the neck or previous surgery to the tongue and larynx. This review will focus on the management of patients who have a difficult airway and require lung isolation. Identification of the potentially difficult airway during the preoperative evaluation allows the preplanning and selection of the appropriate lung isolation device. Common devices used to achieve one-lung ventilation in patients with difficult airways include independent bronchial blockers (Arndt, Cohen, and Fuji Uniblocker). In patients who require one-lung ventilation and who present with a difficult airway, the safest way to establish an airway is by placing a single-lumen endotracheal tube orally or nasotracheally while the patient is awake with the aid of a flexible fiberoptic bronchoscope. Lung isolation in these patients then is achieved by using an independent bronchial blocker; an alternative technique is to use a double-lumen endotracheal tube while using an airway catheter exchange technique. For the patient with a tracheostomy in place, an independent bronchial blocker is recommended.
    Current opinion in anaesthesiology 09/2009; 23(1):12-7. DOI:10.1097/ACO.0b013e328331e8a7 · 2.53 Impact Factor


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