Using Bronchial Blockers for Providing Separate Lung Ventilation in Thoracic Surgery

V.E. Gruzdev, E.S. Gorobets, E.O. Kochkovaya

N.N. Blokhin Russian Cancer Research Center, Ministry of Health of Russian Federation, Moscow

For correspondence: Gruzdev Vadim Evgenievich — M.D., senior research fellow, Department of Anaesthsiology and Intensive care, N.N. Blokhin Russian Cancer Research Center, Ministry of Health of Russian Federation, Moscow; e-mail: vadimgru@yandex.ru

For citation: Gruzdev VE, Gorobets ES, Kochkovaya EO. Using Bronchial Blockers for Providing Separate Lung Ventilation in Thoracic Surgery. Intensive Care Herald. 2017;2:37–42.


Successes in combined treatment of maxillofacial cancer diseases lead to significant increasing of life expectancy, and as a result to growth of lung metastasis frequency. That’s why one of the steps of these diseases therapy is operative metastasectomy. As you know separate lung ventilation, one lung collapse and accordingly one lung ventilation often has to be in thoracic surgery. Earlier we achieved it by usage double-lumen endotracheal tubes. The review of last scientific publications about anesthesia in cancer thoracic surgery convincingly and authentically shew that current bronchial blockers provided safe lung separation in that cases when it didn’t get to spend one lung ventilation because of impossibility to use double-lumen tube. The medical indications for usage bronchial blockers are maxillofacial deformations, abnormal tracheobronchial anatomy, the morbid obesity and tracheostomy. We have analyzed 40 successful cases of modern bronchial blockers application for providing lung collapse on the operation side, estimated possibilities and shown the results of bronchial blockers usage during operations in thoracic cancer surgery.

Кeywords: lung separation, difficult intubation, bronchial blocker, double-lumen endotracheal tube, ETView system, EZ-Blocker

Received: 27.02.2017


References

  1. The Pastorino U., Buyse M., Friedel G. et al. International Registry of Lung Metastases, Writing Committee. Long-term results of lung metastasectomy: prognostic analyses based on 5206 cases. J. Thorac. Cardiovasc. Surg. 1997; 113(1): 37–49.
  2. Brodsky J. Lung separation. In: Cohen E. (ed). The Practice of Thoracic Anesthesia. Philadelphia, PA: Lippincott, 1995: 308– 309.
  3. Jaggar S.I., Mofeez A., Haxby E. Double-lumen tube audit. J. Cardiothorac. Anesth. 2002; 16: 790–791.
  4. Campos J.H. Lung isolation techniques for patients with difficult Current Opinion in Anaesthesiology. 2010; 23(1): 12–17.
  5. Campos J.H., Ueda K. Lung Separation in the Morbidly Obese Patient. Hindawi Publishing Corporation Anesthesiology Research and Practice. 2012. Article ID 207598. doi:10.1155/2012/207598.
  6. Clayton-Smith , Bennett K., Alston R.P. et al. A Comparison of the Efficacy and Adverse Effects of Double-Lumen Endobronchial Tubes and Bronchial Blockers in Thoracic Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Trials.
  7. Cardiothorac. Vasc. Anesth. 2015; 29(4): 955–966. doi: 10.1053/j.jvca.2014.11.017.
  8. Knoll H., Ziegeler S., Schreiber J.U. et al. Airway Injuries after One-lung Ventilation: A Comparison between Double-lumen Tube and Endobronchial Blocker. A Randomized, Prospective, Controlled Anesthesiology. 2006; 105: 471–477.
  9. Rocha A.C., Martins M.G., Silva L.I. et al. Detachment of the carinal hook following endobronchial intubation with a double lumen tube. BMC Anesthesiology. 2011; 11: doi: 10.1186/1471-2253-11-20.
  10. Cohen E. Back To Blockers? The Continued Search for the Ideal Endobronchial Anesthesiology. 2013; 118: 490–493.
  11. Brodsky J.B. Clinical separation of the lungs. Ann. Anesth. Reanim, 1992; 11: 178–192.
  12. Giglio M., Oreste D., Oreste N. Usefulness of ETView TVT endotracheal tube for correct positioning of bronchial blockers in left lobectomy: an easy and safe combination. Minerva Anestesiol. 2009; 75(Suppl. 1 to No: 7–8): 1–4.
  13. Levy-Faber D., Malyanker , Nir R.R., Best L.A., Barak M. Comparison of VivaSight double-lumen tube with a conventional double-lumen tube in adult patients undergoing video-assisted thoracoscopic surgery. Anaesthesia. 2015; 70(11): 1259–1263. doi: 10.1111/anae.13177.
  14. Mourisse J., Liesveld J., Verhagen A. et al. Efficiency, efficacy, and safety of EZ-blocker compared with left-sided double-lumen tube for one-lung ventilation. Anesthesiology. 2013; 118: 550– 561.
  15. Wiser S.H., Hartigan M. Challenging lung isolation secondary to aberrant tracheo-bronchial anatomy. Anesth. Analg. 2011; 112: 688–692.
  16. Lee H., Yang H.M., Kim H.C., Bahk J.H., Seo J.H. Transection of a Coopdech bronchial blocker tip during bronchial resection for right upper lobectomy: a case report. Korean J. Anesthesiol. 2015; 68(3): 287–291.
  17. RomanaE.F., Battafaranob R.J., Grigorec A.M. Anesthesia for tracheal reconstruction and transplantation. Curr. Opin. Anaesthesiol. 2013; 26(1): 1–5.
  18. Ng J.M. Hypoxemia during one-lung ventilation: jet ventilation of the middle and lower lobes during right upper lobe sleeve resection. Analg. 2005; 101(5): 1554–1555.
  19. Hess D.R., Gillette M.A. Tracheal gas insufflation and related techniques to introduce gas flow to the trachea. Respir. Care. 2001; 46(2): 119–129.
  20. Murakami S., Watanabe , Kobayashi H. High frequency jet ventilation in tracheobronchoplasty. An experimental study. Scand. J. Thorac. Cardiovasc. Surg. 1994; 28(1): 31–36.
  21. Heitz W., Shum P.P., Grunwald Z. Use of a tracheoscopic ven- tilation tube for endotracheal intubation in the difficult airway. J. Clin. Anesth. 2011; 23: 403–406.
  22. Груздев В.Е., Горобец Е.С. Периоперационная эпидуральная анальгезия при операциях на легких у больных с низкими функциональными резервами дыхания. Анестезиология и реаниматология. 2015; 60(6): 43–46. [Gruzdev V.E., Gorobets E.S. Perioperatsionnaya epidural’naya anal’geziya pri operatsiyah na legkih u bol’nyh s nizkimi funktsional’nymi rezer- vami dyhaniya. Anesteziologiya i reanimatologiya. 2015; 60(6): 43–46. (In Russ)]