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1.
BMJ Case Rep ; 14(2)2021 Feb 17.
Artigo em Inglês | MEDLINE | ID: mdl-33597165

RESUMO

Placement of a double-lumen tube to achieve one lung ventilation is an aerosol-generating procedure. Performing it on a patient with COVID-19 will put healthcare workers at high risk of contracting the disease. We herein report a case of its use in a patient with traumatic diaphragmatic rupture, who was also suspected to have COVID-19. This article aims to highlight the issues, it presented and ways to address them as well as the perioperative impact of personal protective equipment.


Assuntos
/prevenção & controle , Pessoal de Saúde/normas , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Ventilação Monopulmonar/normas , Equipamento de Proteção Individual/normas , Acidentes de Trânsito , Adulto , /transmissão , Diafragma/lesões , Diafragma/cirurgia , Humanos , Masculino , Ventilação Monopulmonar/instrumentação , Guias de Prática Clínica como Assunto , /etiologia , Ruptura/etiologia , Ruptura/terapia
2.
BMJ Case Rep ; 13(12)2020 Dec 22.
Artigo em Inglês | MEDLINE | ID: mdl-33370965

RESUMO

Tracheal tear after endotracheal intubation is extremely rare. The role of silicone Y-stent in the management of tracheal injury has been documented in the previous studies. However, none of the studies have mentioned the deployment of silicone Y-stent via rigid bronchoscope with the patient solely supported by extracorporeal membrane oxygenation (ECMO) without general anaesthesia delivered via the side port of the rigid bronchoscope. We report a patient who had a tracheal tear due to endotracheal tube migration following a routine video-assisted thoracoscopic surgery sympathectomy, which was successfully managed with silicone Y-stent insertion. Procedure was done while she was undergoing ECMO; hence, no ventilator connection to the side port of the rigid scope was required. This was our first experience in performing Y-stent insertion fully under ECMO, and the patient had a successful recovery.


Assuntos
Oxigenação por Membrana Extracorpórea , Complicações Intraoperatórias/terapia , Intubação Intratraqueal/efeitos adversos , Lacerações/terapia , Traqueia/lesões , Broncoscopia , Falha de Equipamento , Feminino , Humanos , Doença Iatrogênica , Complicações Intraoperatórias/diagnóstico , Complicações Intraoperatórias/etiologia , Intubação Intratraqueal/instrumentação , Lacerações/diagnóstico , Lacerações/etiologia , Enfisema Mediastínico/etiologia , Enfisema Mediastínico/terapia , Ventilação Monopulmonar/instrumentação , Stents , Simpatectomia/efeitos adversos , Simpatectomia/métodos , Cirurgia Torácica Vídeoassistida/efeitos adversos , Cirurgia Torácica Vídeoassistida/métodos , Traqueia/diagnóstico por imagem , Adulto Jovem
5.
Thorac Surg Clin ; 30(3): 279-291, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32593361

RESUMO

The intraoperative anesthetic management for thoracic surgery can impact a patient's postoperative course, especially in patients with significant lung disease. One-lung ventilation poses an inherent risk to patients, including hypoxemia, acute lung injury, and right ventricular dysfunction. Patient-specific ventilator management strategies during one-lung ventilation can reduce postoperative morbidity.


Assuntos
Anestesia/métodos , Ventilação Monopulmonar/métodos , Procedimentos Cirúrgicos Torácicos , Lesão Pulmonar Aguda/etiologia , Hidratação , Humanos , Hipóxia/etiologia , Ventilação Monopulmonar/efeitos adversos , Ventilação Monopulmonar/instrumentação , Manejo da Dor , Complicações Pós-Operatórias/prevenção & controle , Procedimentos Cirúrgicos Torácicos/efeitos adversos
6.
Vet Surg ; 49 Suppl 1: O93-O101, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31588587

RESUMO

OBJECTIVE: To evaluate the feasibility of fluoroscopy-assisted placement of one-lung ventilation (OLV) devices in dogs. STUDY DESIGN: Experimental study. SAMPLE POPULATION: Canine cadavers (n = 8) weighing between 20.2 and 37.4 kg. METHODS: Thoracoscopic access with a two-port approach was established to evaluate bilateral lung ventilation patterns. Advancement of a left-sided Robertshaw double-lumen endobronchial tube (DLT) and the EZ-blocker (EZ) were evaluated under direct fluoroscopic guidance. Each dog also underwent bronchoscopy-assisted placement of an Arndt endobronchial blocker (EBB). Time to initial placement, success of creating complete OLV (after initial placement attempt and after up to two repositionings), and ease of placement score were recorded. Device position was evaluated bronchoscopically after each fluoroscopy-assisted placement attempt. RESULTS: Time to initial placement was significantly shorter for EZ than for DLT and EBB. The rate of successful placement after up to two repositioning attempts was 87.5%, 87.5%, and 100.0% on the right and 87.5%, 100.0%, 100.0% on the left for DLT, EZ, and EBB, respectively, and was not different between devices. Ease of placement scores were significantly higher for DLT compared with EZ and EBB on both the left and the right sides. CONCLUSION: Fluoroscopy-assisted placement of DLT and EZ appears feasible in canine cadavers. EZ-blocker placement was efficient and technically easier than DLT, but positioning must be adapted for dogs. Bronchoscopy-assisted placement of EBB remains highly successful. CLINICAL SIGNIFICANCE: Fluoroscopy-assisted placement of EZ and DLT is a useful alternative to bronchoscopy-assisted placement of these OLV devices.


Assuntos
Cães , Ventilação Monopulmonar/veterinária , Cirurgia Torácica Vídeoassistida/veterinária , Animais , Cadáver , Intubação Intratraqueal/métodos , Intubação Intratraqueal/veterinária , Ventilação Monopulmonar/instrumentação
7.
BMC Pulm Med ; 19(1): 207, 2019 Nov 09.
Artigo em Inglês | MEDLINE | ID: mdl-31706317

RESUMO

BACKGROUND: To compare the therapeutic value of a bronchial blocker (BB) with a double-lumen tube (DLT) in minimally invasive cardiac surgery (MICS). METHODS: Sixty patients who underwent MICS were randomized to use either a DLT (Group D, n = 30) or a BB (Group B, n = 29; one failed was omitted). The following data were collected: time of intubation and tube localization; incidence of tube displacement; postoperative sore throat and hoarseness; time of cardiopulmonary bypass; maintenance time for SpO2 < 90% (PaCO2 < 60 mmHg); mean arterial pressure and heart rate; SpO2, PaO2, PaCO2, EtCO2, mean airway pressure, and airway peak pressure; surgeons' satisfaction with anesthesia; and short-term complications. RESULTS: The times of intubation and tube localization were significantly longer in Group B than in Group D (P < 0.05). Patients in Group B exhibited significantly lower incidence of tube displacement, postoperative sore throat, and hoarseness when compared with patients in Group D (P < 0.05). Mean arterial pressure and heart rate were significantly lower in Group B than in Group D after tracheal intubation (P < 0.05). The mean airway pressure and airway peak pressure were significantly lower in Group B than in Group D after one-lung ventilation (P < 0.05). SpO2 and PaO2 in Group B were significantly higher than in group D after cardiopulmonary bypass (P < 0.05). No short-term postoperative complications were observed in patients of Groups B and D during 3 month follow-up. CONCLUSION: BB can be a potential alternative to the conventional DLT for lung isolation in MICS. TRIAL REGISTRATION: ChiCTR1900024250, July 2, 2019.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Intubação Intratraqueal/instrumentação , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Ventilação Monopulmonar/instrumentação , Adulto , Idoso , Desenho de Equipamento , Feminino , Seguimentos , Doenças das Valvas Cardíacas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/cirurgia , Complicações Pós-Operatórias , Estudos Retrospectivos , Valva Tricúspide/cirurgia
9.
Anesth Analg ; 129(6): 1692-1698, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31743190

RESUMO

BACKGROUND: Lung isolation with bronchial blockers is a well-described and accepted procedure, often described for use during the management of massive hemoptysis. Recommendations for balloon inflation are sparse, with some advocating for saline whereas other suggest air, including the manufacturers. We sought to evaluate the optimal method for balloon inflation in an ex vivo trial. METHODS: We performed a prospective trial utilizing 3 commercially available bronchial blockers commonly described for use in lung isolation and massive hemoptysis management. We utilized the Arndt Endobronchial Blocker (Cook Medical), the Cohen Tip Deflecting Endobronchial Blocker (Cook Medical), and the Fogarty Venous Thrombectomy Catheter (Edwards LifeSciences). Balloon size and deflation assessment were tested within 3 different scenarios comparing air versus saline.Welch t test was performed to compare means between groups, and a generalized estimating equation model was utilized to compare balloon diameter over time to account for correlation among repeated measures from the same balloon. RESULTS: All 3 endobronchial blocker systems were observed in triplicate. During free-standing balloon inflation, all 3 endobronchial systems displayed a greater degree of balloon deflation over time with air as opposed to saline (P < .001). Within a stent-based model, inflation with air of all 3 endobronchial systems, according to manufacturer recommendations, demonstrated significantly decreased time until fluid transgression occurred when compared to a saline model (P < .001). Within a stent-based model, inflation with air, according to clinical judgment, demonstrated significantly decreased time until fluid transgression in the Arndt (P = .016) and the Fogarty (P < .001) system, but not the Cohen (P = .173) system, when compared with saline. CONCLUSIONS: The utilization of saline for balloon inflation during bronchial blockade allows for more consistent balloon inflation. The use of saline during balloon inflation appears to delay passive, spontaneous balloon deflation time when compared to air during a model of endobronchial blockade. The approach of saline inflation should be tested in humans to demonstrate the overall applicability and validity of the current findings.


Assuntos
Obstrução das Vias Respiratórias/terapia , Brônquios , Intubação Intratraqueal/instrumentação , Intubação Intratraqueal/métodos , Ventilação Monopulmonar/instrumentação , Ventilação Monopulmonar/métodos , Humanos , Estudos Prospectivos , Respiração Artificial/instrumentação , Respiração Artificial/métodos
10.
Paediatr Anaesth ; 29(9): 915-919, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31270907

RESUMO

BACKGROUND: One-lung ventilation is a challenging airway technique in the pediatric population. Multiple airway devices can be employed, but there is no consensus as to the most reliable and physiologically advantageous method. This report is a review of the methods of one-lung ventilation in children in our practice, as well as an analysis of the impact of airway device type, patient age, and duration of lung separation on respiratory mechanics and gas exchange. METHODS: The records of all pediatric patients undergoing procedures requiring one-lung ventilation in a single center over an 18-month period were reviewed. Demographics, time required to achieve lung separation (anesthesia ready-time), and duration of one-lung ventilation were collected. Data from arterial blood gas analysis and ventilator parameters were collected at three time points: 15 minutes prior to one-lung ventilation (pre-OLV), 15 minutes after initiation of one-lung ventilation (during OLV), and 15 minutes after one-lung ventilation was ended (post-OLV). Standard equations for calculating compliance, the ratio of arterial partial pressure of oxygen to the fraction of inspired oxygen, and the alveolar-arterial oxygen gradient were used. RESULTS: Forty-six patients were identified with a mean age of 9.3 (inner quartile range 3-15) years. All patients had significant changes in pulmonary function when comparing pre-OLV with during OLV and when comparing during OLV with post-OLV. There were no significant changes from pre- to post-OLV. On further analysis, there were more pronounced changes in compliance and gas exchange in older patients (P = 0.003; 95% CI: -0.62 to -0.14). There was also a significant decrease in post-OLV compliance with a longer duration of OLV (P = 0.018; 95% CI: -0.02 to <-0.01). Airway device type did not have significant impact on the parameters examined. CONCLUSION: Our report demonstrates significant changes in lung function during one-lung ventilation. One particular device does not seem to be superior. Though pre-OLV measures of pulmonary function correlate closely with post-OLV, older age and a prolonged duration of one-lung ventilation did impact compliance.


Assuntos
Complacência Pulmonar , Ventilação Monopulmonar/métodos , Adolescente , Idoso , Gasometria , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Pulmão , Masculino , Pessoa de Meia-Idade , Ventilação Monopulmonar/instrumentação , Respiração Artificial/métodos
11.
Thorac Cancer ; 10(6): 1448-1452, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31115153

RESUMO

In routine practice, one lung ventilation (OLV) is initiated upon pleural opening. We conducted a randomized controlled trial to compare lung collapse after preemptive OLV versus conventional OLV in thoracoscopic surgery. A total of 67 patients were enrolled (34 with conventional OLV; 33 with preemptive OLV). Preemptive OLV was conducted by closing the DLT lumen to the non-ventilated lung immediately upon assuming the lateral position with the distal port closed to the atmosphere until pleural opening (>6 minutes in all cases). Lung collapse was assessed at 1, 5, 10, 20, 30 and 40 minutes after pleural opening using a 10-point rating scale (10: complete collapse). The primary end point was the duration from pleural opening to satisfactory lung collapse (score of 8). Secondary end points included PaO2 and hypoxemia. The duration from pleural opening to satisfactory lung collapse was shorter in the preemptive OLV group (9.1 ± 1.2 vs. 14.1 ± 4.7 minutes, P < 0.01). PaO2 was comparable between the two groups prior to anesthetic induction (T0), and 20 (T2), 40 minutes (T3) after pleural incision, but was lower in the preemptive OLV group at zero minutes after pleural incision (T1) (457.5 ± 19.0 vs. 483.1 ± 18.1 mmHg, P < 0.01). No patients in either group developed hypoxemia. In summary, preemptive OLV expedites lung collapse during thoracoscopic surgery with minimal safety concern.


Assuntos
Ventilação Monopulmonar/métodos , Pleura/cirurgia , Atelectasia Pulmonar/prevenção & controle , Cirurgia Torácica Vídeoassistida/instrumentação , Idoso , Constrição , Método Duplo-Cego , Feminino , Humanos , Hipóxia/epidemiologia , Hipóxia/etiologia , Masculino , Pessoa de Meia-Idade , Ventilação Monopulmonar/instrumentação , Atelectasia Pulmonar/etiologia , Atelectasia Pulmonar/terapia , Cirurgia Torácica Vídeoassistida/efeitos adversos , Resultado do Tratamento
13.
Medicine (Baltimore) ; 98(14): e15116, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30946382

RESUMO

BACKGROUND: The use of bronchial blockers has been increased for one-lung ventilation; however, the placement of bronchial blockers is time consuming. The objective of this study was to compare the novel extraluminal technique of Uniblocker placement supported by trachea length measurement on computerized tomography images with conventional intraluminal Uniblocker placement method. METHODS: Seventy adult patients undergoing left side thoracic surgery were included in the study. All the patients were randomly assigned to one of two groups: conventional intraluminal intubation group (CV-IN group, n = 35) or extraluminal CT guided group (CT-EX group, n = 35). The primary endpoints were the optimal positions of Uniblocker and the injuries of bronchi and carina. The secondary outcomes included the time of Uniblocker placement, the adequacy of lung collapse, the incidences of Uniblocker displacement, sore throat, and hoarseness postoperative. RESULTS: In the CV-IN group, 19 of 35 Uniblockers went to the left main-stem bronchus on the initial blind insertion and 15 of 35 Uniblockers were considered as in optimal depth, whereas in the CT-EX group, 32 of 35 Uniblockers went to the left main-stem bronchus on the initial blind insertion and 31 of 35 Uniblockers were considered as in optimal depth (P < .01). The incidence of bronchi and carina injuries was obviously lower in the CT-EX group (occurred in 1 of 35 cases) than that in the CV-IN group (occurred in 8 of 35 cases) (P < .05). The time of Uniblocker placement took 145.4 s in the CV-IN group and 85.4 s in the CT-EX group (P < .01). The malpositions of Uniblocker, the degree of pulmonary collapse and the adverse events postoperative such as sore throat and hoarseness were not significantly different between the two groups (P > .05). CONCLUSION: The novel extraluminal technique of Uniblocker placement supported by trachea length measurement on computerized tomography images was proved to be more rapid, more accurate and less complications than conventional intraluminal Uniblocker placement method.


Assuntos
Ventilação Monopulmonar/instrumentação , Procedimentos Cirúrgicos Torácicos/instrumentação , Traqueia/diagnóstico por imagem , Adulto , Broncoscopia , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ventilação Monopulmonar/efeitos adversos , Ventilação Monopulmonar/métodos , Duração da Cirurgia , Procedimentos Cirúrgicos Torácicos/efeitos adversos , Procedimentos Cirúrgicos Torácicos/métodos , Tomografia Computadorizada por Raios X , Traqueia/anatomia & histologia
15.
Korean J Anesthesiol ; 72(1): 24-31, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30205667

RESUMO

BACKGROUND: As lung ultrasound (LUS) can be used to identify regional lung ventilation and collapse, we hypothesize that LUS can be better than auscultation in assessing lung isolation and determining double lumen tube (DLT) position. METHODS: A randomized controlled study was conducted in tertiary care cancer institute from November 2014 to December 2015, including 100 adult patients undergoing elective thoracic surgeries. Patients with tracheostomy, difficult airway and pleural-based pathologies were excluded. After anesthesia induction and DLT insertion, patients were randomized into group A (auscultation) and group B (LUS). Regional ventilation was assessed by experienced anesthesiologists using the respective method for each group. Final confirmation of DLT position with a bronchoscope was performed by a blinded anesthesiologist. Contingency tables were plotted to determine sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy for each method. RESULTS: Data from 91 patients were analyzed (group A = 47, group B = 44). Compared with auscultation, LUS had significantly higher sensitivity (94.1% vs. 73.3%, P = 0.010), PPV (57.1% vs. 35.5%, P = 0.044), NPV (93.8% vs. 75.0%, P = 0.018), accuracy (70.5% vs. 48.9%, P = 0.036) and required longer median time (161.5 vs. 114 s, P < 0.001) for assessment of DLT position. Differences in specificity (55.6% vs. 37.5%, P = 0.101) and area under curve (0.748; 95% CI: 0.604-0.893 vs. 0.554, 95% CI: 0.379-0.730; P = 0.109) were not significant. CONCLUSIONS: Compared to auscultation, LUS is a superior method for assessing lung isolation and determining DLT position.


Assuntos
Auscultação/métodos , Pulmão/diagnóstico por imagem , Ventilação Monopulmonar/métodos , Procedimentos Cirúrgicos Torácicos/métodos , Ultrassonografia/métodos , Adulto , Idoso , Método Duplo-Cego , Procedimentos Cirúrgicos Eletivos/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/cirurgia , Ventilação Monopulmonar/instrumentação , Estudos Prospectivos , Atenção Terciária à Saúde , Procedimentos Cirúrgicos Torácicos/instrumentação
16.
Korean J Anesthesiol ; 72(2): 184-187, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30553237

RESUMO

BACKGROUND: Double-lumen tubes (DLT) and endobronchial blockers (EB) are used for one-lung ventilation in thoracic surgery. More complications are seen when using DLT when compared to EB, while major complications are rarely seen. CASE: This case report describes a perforation of the right mainstem bronchus by an EZ-Blocker EB in a patient undergoing a minimally invasive esophagectomy after neoadjuvant chemoradiation. CONCLUSIONS: We advise to insert an EZ-BlockerTM EB with caution and only under direct bronchoscopic visualization, especially in previous irradiated patients.


Assuntos
Brônquios/lesões , Quimiorradioterapia/tendências , Esofagectomia/efeitos adversos , Esôfago/cirurgia , Terapia Neoadjuvante/tendências , Ventilação Monopulmonar/efeitos adversos , Idoso , Esofagectomia/instrumentação , Humanos , Intubação Intratraqueal/efeitos adversos , Intubação Intratraqueal/instrumentação , Masculino , Ventilação Monopulmonar/instrumentação
18.
Korean J Anesthesiol ; 72(1): 32-38, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-29921088

RESUMO

BACKGROUND: Compared to an equivalent sized polyvinyl chloride (PVC) double-lumen tube (DLT), a silicone DLT has a shorter endobronchial segment. The aim of this study was to compare the incidence of clinically significant displacement of left-sided PVC and silicone DLTs after a positional change to a lateral position from a supine position and determine its effect on the need for DLT repositioning for successful lung separation in patients undergoing thoracic surgery. METHODS: One hundred eight adult patients requiring one-lung ventilation were randomly divided into group P (PVC DLT, n = 54) and group S (Silicone DLT, n = 54). The position of the DLT was observed before and after lateral positioning to assess the effect of the position change. The incidence of clinically significant displacement (> 10 mm) of DLT was compared between the groups. RESULTS: DLTs were clinically significantly displaced in group P (17/48, 35.4%) and group S (18/52, 34.6%) after lateral positioning (P = 0.933). A proximal displacement (31.3% [group P] and 25.0% [group S]) was more common than distal displacement (4.2% [group P] and 9.6% [group S]), with no significant intergroup difference (P = 0.494). After lateral positioning, critical malposition of DLT with bronchial herniation to the right main bronchus was 8.3% (group P) and 7.9% (group S, P = 0.906). CONCLUSIONS: Left-sided PVC and silicone DLTs produced comparable incidences of clinically significant displacement and, consequently, required similar rates of repositioning for successful lung separation after lateral positioning.


Assuntos
Intubação Intratraqueal/instrumentação , Ventilação Monopulmonar/instrumentação , Procedimentos Cirúrgicos Torácicos/instrumentação , Adulto , Idoso , Feminino , Humanos , Intubação Intratraqueal/efeitos adversos , Masculino , Pessoa de Meia-Idade , Posicionamento do Paciente , Cloreto de Polivinila , Estudos Prospectivos , Silicones , Método Simples-Cego
19.
Medicine (Baltimore) ; 97(36): e12237, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30200151

RESUMO

RATIONALE: One-lung ventilation (OLV) is required during most thoracic surgeries to facilitate surgical visualization by collapsing the lung. Double-lumen tubes and bronchial blockers are two commonly used devices for OLV; however, it may be difficult to place two devices in patients with narrow inlets, such as those that have tumor-induced airway stenosis. PATIENT CONCERNS: We report the case of an adult patient with a lung tumor that was growing rapidly and hemorrhaging; thus, a thoracotomy for lung resection should have been performed as early as possible. However, a large mass on the glottis obstructed the entry of the double-lumen tube or bronchial blocker. Therefore, the operation could not be performed because of the inability to provide one-lung ventilation via the conventional intubation method. DIAGNOSES: Computed tomography (CT) revealed a lung tumor that was growing rapidly and preoperative bronchoscopy showed a large mass on the vocal cords. INTERVENTIONS: After anesthesia induction, a Uniblocker and a small single lumen tube were intubated and the Uniblocker was inserted extraluminally of the single lumen tube. One-lung ventilation was achieved successfully in this patient. OUTCOMES: The surgery proceeded uneventfully for 4 hours without any complications. LESSONS: Extraluminal use of the Uniblocker and a small single lumen tube may be recommended for patients receiving OLV and who have narrow inlets, especially under emergency situations.


Assuntos
Doenças da Laringe/complicações , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/cirurgia , Ventilação Monopulmonar/métodos , Glote/diagnóstico por imagem , Humanos , Doenças da Laringe/diagnóstico por imagem , Neoplasias Pulmonares/diagnóstico por imagem , Pessoa de Meia-Idade , Ventilação Monopulmonar/instrumentação
20.
J Cardiothorac Surg ; 13(1): 77, 2018 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-29940993

RESUMO

BACKGROUND: In certain clinical situations the insertion of a double-lumen tube (DLT) for one-lung ventilation (OLV) is not feasible or unfavorable. In these cases, the EZ-Blocker (EZB) may serve as an alternative. The aim of our analysis was to report on the clinical applications and our experience with the EZB for one-lung ventilation in 100 patients undergoing thoracic surgery. METHODS: All anesthetic records from patients older than 18 years of age undergoing general anesthesia in the department of thoracic surgery with intraoperative use of an EZB for OLV at the University Hospital of Erlangen in four consecutive years were analyzed retrospectively. RESULTS: Most frequently, EZB was used in difficult airway (27%) and for surgical procedures with high risk for left recurrent laryngeal nerve injury (21%), followed by application in intubated (12%) or tracheostomized (11%) patients. 11% of the patients had an increased risk of gastric regurgitation. Almost all EZBs were placed free of complications (99%). Clinically sufficient lung collapse was achieved in all patients. No serious airway injuries or immediate complications were documented. CONCLUSIONS: The EZB is an efficient, easy-to-use and safe airway device and enables OLV in several clinical situations, when conventional DLTs are not feasible or less favorable. Three major applications were depicted from the data: expected difficult airway, surgical procedures with necessity of intraoperative recurrent laryngeal nerve monitoring and already intubated or tracheostomized patients.


Assuntos
Intubação Intratraqueal , Ventilação Monopulmonar/métodos , Nervo Laríngeo Recorrente/patologia , Procedimentos Cirúrgicos Torácicos , Idoso , Anestesia Geral , Feminino , Humanos , Período Intraoperatório , Intubação Intratraqueal/efeitos adversos , Masculino , Pessoa de Meia-Idade , Ventilação Monopulmonar/instrumentação , Atelectasia Pulmonar/etiologia , Respiração Artificial/efeitos adversos , Estudos Retrospectivos , Procedimentos Cirúrgicos Torácicos/efeitos adversos , Traqueostomia
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