Use of the Arndt wire-guided endobronchial blocker via nasal for OLV 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: 3.3). 08/2005; 28(1):174-5. DOI: 10.1016/j.ejcts.2005.03.013
Source: PubMed


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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Available from: Chun Yu Chen, Oct 09, 2015
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    • "As described in this case, when lung separation is critical and the orotracheal route is unsuccessful or not possible, we advocate nasotracheal intubation using a standard nasal endotracheal tube and deploying an independent bronchial blocker such as the wire-guided Arndt endobronchial blocker, Cohen™ endobronchial blocker or Fuji™ endobronchial blocker. The Arndt® blocker for nasotracheal intubation and lung isolation has been reported [11,12] but not in the context of penetrating chest trauma. A common problem for the thoracic anaesthetist is determining bronchoscope-endotracheal tube-blocker compatibility; therefore, a list of compatible endotracheal tubes, bronchoscopes and bronchial blockers is presented in Table 1. "
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    ABSTRACT: Introduction We report a case of deliberate self-harm in which three three-inch nails were fired from a nail gun resulting in mandibular fixation and two penetrating injuries to the right cardiac ventricle. This combination of high-velocity penetrating injury has not been previously described. Case presentation A 69-year-old Caucasian man with a medical history of chronic depression was brought to hospital after a failed suicide attempt. The attempt consisted of self-asphyxiation with car exhaust fumes and shooting himself thrice with a three-inch nail gun. He sustained a penetrating nail injury to the floor of his mouth, effectively pinning his mouth closed, and penetrating injuries to the right ventricular free wall and at the junction of the right atrioventricular septum. The patient required emergency surgery with requirements for thoracotomy and sternotomy, lung isolation and cardiopulmonary bypass. Conclusions This is the first reported case of a combination high-velocity penetrating nail gun injury to the face and the right cardiac ventricle. This rare case offers airway strategies to accommodate the surgical requirement for lung separation for penetrating chest trauma in a patient with iatrogenically limited mouth opening.
    Journal of Medical Case Reports 05/2013; 7(1):137. DOI:10.1186/1752-1947-7-137
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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 · 1.98 Impact Factor
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