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Zhang D, Liu Y, Zhong W, Huang C, Wang S, Wei J. Perforation of the Left Main Bronchus With a Bronchial Blocker Used for Lung Isolation During Thoracic Surgery. J Cardiothorac Vasc Anesth 2024; 38:859-861. [PMID: 38228426 DOI: 10.1053/j.jvca.2023.12.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 12/08/2023] [Accepted: 12/16/2023] [Indexed: 01/18/2024]
Affiliation(s)
- Dengwen Zhang
- Guangdong Provincial People's Hospital, Guangzhou, China; Guangdong Provincial People's Hospital Heyuan Hospital, Heyuan, China
| | - Yingzhu Liu
- Guangdong Provincial Hospital of Chinese Medicine, Second Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Wenzhao Zhong
- Guangdong Provincial People's Hospital, Guangzhou, China
| | - Chunzhong Huang
- Guangdong Provincial People's Hospital Heyuan Hospital, Heyuan, China
| | - Sheng Wang
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jinfeng Wei
- Guangdong Provincial People's Hospital, Guangzhou, China.
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2
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Serio P, Fainardi V, Coletta R, Grasso A, Baggi R, Rufini P, Avenali S, Ricci Z, Morabito A, Trabalzini F. Conservative management of posterior tracheal wall injury by endoscopic stent placement in children: Preliminary data of three cases. Int J Pediatr Otorhinolaryngol 2022; 159:111214. [PMID: 35759914 DOI: 10.1016/j.ijporl.2022.111214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/17/2022] [Accepted: 06/18/2022] [Indexed: 11/26/2022]
Abstract
The management of tracheal wall lacerations is debated. Current treatments are mainly derived by the experience on adults and include conservative or surgical treatments depending on the clinical condition of the patient. We report our preliminary data with removable tracheal stents in 3 children with tracheal tears and respiratory failure. If performed in specialized centers with appropriate endoscopic and clinical follow-up, airway stents can be considered a valid and safe conservative treatment for tracheal tears and an alternative to intubation or tracheostomy. Further studies are needed to compare different therapeutic options and better define the management and duration of stent treatment.
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Affiliation(s)
- P Serio
- Department of Paediatric Anaesthesia and Intensive Care, Meyer Children Hospital, Florence, Italy.
| | - V Fainardi
- Department of Medicine and Surgery, Cystic Fibrosis Unit, University of Parma, Italy
| | - R Coletta
- Department of Paediatric Surgery, Meyer Children Hospital, University of Florence, Florence, Italy
| | - A Grasso
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - R Baggi
- Respiratory Endoscopy Unit, Meyer Children Hospital, Florence, Italy
| | - P Rufini
- Department of Paediatric Anaesthesia and Intensive Care, Meyer Children Hospital, Florence, Italy
| | - S Avenali
- Respiratory Endoscopy Unit, Meyer Children Hospital, Florence, Italy
| | - Z Ricci
- Department of Paediatric Anaesthesia and Intensive Care, Meyer Children Hospital, Florence, Italy
| | - A Morabito
- Department of Paediatric Surgery, Meyer Children Hospital, University of Florence, Florence, Italy
| | - F Trabalzini
- Department of Otolaryngology, Meyer Children Hospital, Florence, Italy
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3
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Radakovic D, Lazarus M, Leyh RG, Aleksic I. Venovenous extracorporeal membrane oxygenation for the management of contralateral iatrogenic bronchus perforation during lower bilobectomy. Eur J Cardiothorac Surg 2019; 53:475-476. [PMID: 28957991 DOI: 10.1093/ejcts/ezx312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Revised: 07/25/2017] [Accepted: 08/02/2017] [Indexed: 11/14/2022] Open
Abstract
Tracheobronchial rupture by a double-lumen endobronchial tube is a rare but life-threatening complication. We report a case of bronchial rupture during contralateral bilobectomy. Venovenous extracorporeal membrane oxygenation support was instituted via the right femoral vein and the internal jugular vein with the patient in the left lateral decubitus position. Sleeve resection of the ruptured bronchus was performed. The patient was successfully discharged home. Rapid institution of venovenous extracorporeal membrane oxygenation is helpful to manage this intraoperative complication.
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Affiliation(s)
- Dejan Radakovic
- Department of Thoracic and Cardiovascular Surgery, Julius-Maximilians-University Hospital, Würzburg, Germany
| | - Marc Lazarus
- Department of Anaesthesia and Critical Care, Julius-Maximilians-University Hospital, Würzburg, Germany
| | - Rainer G Leyh
- Department of Thoracic and Cardiovascular Surgery, Julius-Maximilians-University Hospital, Würzburg, Germany
| | - Ivan Aleksic
- Department of Thoracic and Cardiovascular Surgery, Julius-Maximilians-University Hospital, Würzburg, Germany
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4
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Ghosh I, Behera P, Das B, Gerber CJ. Subcutaneous emphysema after endotracheal intubation: A case report. Saudi J Anaesth 2018; 12:348-349. [PMID: 29628856 PMCID: PMC5875234 DOI: 10.4103/sja.sja_533_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Indranil Ghosh
- Department of Neuroanaesthesiology, Institute of Neurosciences, Kolkata, West Bengal, India
| | - Prasanta Behera
- Department of Neuroanaesthesiology, Institute of Neurosciences, Kolkata, West Bengal, India
| | - Bibhukalyani Das
- Department of Neuroanaesthesiology, Institute of Neurosciences, Kolkata, West Bengal, India
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5
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Laughland F, Brand J, Round S, Khan K. Iatrogenic Tracheal Rupture During Cardiac Arrest. J Cardiothorac Vasc Anesth 2017; 32:1403-1406. [PMID: 29158059 DOI: 10.1053/j.jvca.2017.08.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Indexed: 12/14/2022]
Affiliation(s)
- Fiona Laughland
- Department of Cardiothoracic Critical Care, James Cook University Hospital, Middlesbrough, United Kingdom
| | - Jonathan Brand
- Department of Cardiothoracic Anaesthesia and Critical Care, James Cook University Hospital, Middlesbrough, United Kingdom.
| | - Sarah Round
- Department of Cardiothoracic Anaesthesia and Critical Care, James Cook University Hospital, Middlesbrough, United Kingdom
| | - Khalid Khan
- Department of Cardiothoracic Anaesthesia and Critical Care, James Cook University Hospital, Middlesbrough, United Kingdom
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Jiang ZM, Zhang C, Chen ZH. Iatrogenic rupture of the left main bronchus secondary to repeated surgical lobe torsion during double-lumen tube placement: A case report. Medicine (Baltimore) 2017; 96:e7694. [PMID: 28767602 PMCID: PMC5626156 DOI: 10.1097/md.0000000000007694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Bronchial rupture is a rare but potentially life-threatening complication during double-lumen endobronchial tube placement. The rupture of the left main bronchus resulting from repeated surgical torsion is uncommon. PATIENT CONCERNS A 70-year-old man with a history of chronic obstructive pulmonary disease (COPD), intermediate emphysema, chronic bronchitis, hypertension, type 2 diabetes mellitus, and L3-L4 lumbar intervertebral disc herniation. Chest x-ray and computed tomography revealed a solitary pulmonary nodule in the left lower lobe. DIAGNOSES Left lower lobe carcinoma. INTERVENTIONS To improve surgical access, forceps were used to oppress and torque the left lung. OUTCOMES An irregular, circular, horizontal, full-thickness rupture of 1.2 cm was observed at the tip of the bronchial tube in the left main bronchus upon examination of the bronchial stump.The rupture was repaired via primary suturing with 4-0 prolene thread and secondary reinforcement with a pericardial flap through a left thoracotomy, with no further complications. LESSONS Caution should be exercised during compression and torsion of the pulmonary lobe when attempting to improve surgical access, especially in patients with COPD. Conversion to thoracotomy is recommended if other measures have been unsuccessful.
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Affiliation(s)
| | - Chu Zhang
- Department of Thoracic surgery, Shaoxing People's Hospital (Shaoxing Hospital of Zhejiang University), Shaoxing, P.R. China
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7
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Honikman R, Rodriguez-Diaz CA, Cohen E. A Ballooning Crisis: Three Cases of Bronchial Blocker Malfunction and A Review. J Cardiothorac Vasc Anesth 2017; 31:1799-1804. [PMID: 28476448 DOI: 10.1053/j.jvca.2017.02.039] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Rafael Honikman
- Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, New York, NY.
| | | | - Edmond Cohen
- Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, New York, NY
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Warner MA, Fox JF. Direct Laryngoscopy and Endotracheal Intubation Complicated by Anterior Tracheal Laceration Secondary to Protrusion of Preloaded Endotracheal Tube Stylet. ACTA ACUST UNITED AC 2016; 6:77-9. [DOI: 10.1213/xaa.0000000000000235] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Lim H, Kim JH, Kim D, Lee J, Son JS, Kim DC, Ko S. Tracheal rupture after endotracheal intubation - A report of three cases -. Korean J Anesthesiol 2012; 62:277-80. [PMID: 22474557 PMCID: PMC3315660 DOI: 10.4097/kjae.2012.62.3.277] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2011] [Revised: 07/23/2011] [Accepted: 07/27/2011] [Indexed: 11/10/2022] Open
Abstract
Tracheal rupture is a rare but serious complication that occurs after endotracheal intubation. It usually presents as a linear lesion in the membranous wall of the trachea, and is more prevalent in women and patients older than 50 years. The clinical manifestations of tracheal injury include subcutaneous emphysema and respiratory distress. We report the cases of three female patients of old age presenting tracheal rupture after endotracheal intubation. Two cases received surgical repair without complication and one recovered uneventfully after conservative management. We presume that the tracheal injuries were caused by over-inflation of cuff and sudden movement of the tube by positional change. Therefore, we recommend cuff pressure monitoring during general anesthesia and minimized movement of the head and neck at positional change.
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Affiliation(s)
- Hyungsun Lim
- Department of Anesthesiology and Pain Medicine, Chonbuk National University Medical School, Jeonju, Korea
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10
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Kim HK, Jun JH, Lee HS, Choi YR, Chung MH. Left mainstem bronchial rupture during one-lung ventilation with Robertshaw double lumen endobronchial tube -A case report-. Korean J Anesthesiol 2010; 59 Suppl:S21-5. [PMID: 21286443 PMCID: PMC3030039 DOI: 10.4097/kjae.2010.59.s.s21] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2010] [Revised: 04/02/2010] [Accepted: 04/13/2010] [Indexed: 11/10/2022] Open
Abstract
Lung separation using a double-lumen endobronchial tube is necessary for video assisted thoracoscopy (VATs). Bronchial rupture after intubation with a double-lumen endobronchial tube has been rarely reported. We report a case of a 70-year-old man who had solitary pulmonary nodule in his right upper lobe. He was intubated with a left-sided Robertshaw double-lumen endobronchial tube. He underwent a VATs right upper lobectomy with the one-lung ventilation of left lung. During the operation, the rupture of the left mainstem bronchus was detected. Immediately, the thoracotomy was performed and the ruptured left mainstem bronchus was repaired with absorbable sutures (vicryl). Seven days later he had a bronchoscopy to examine the left mainstem bronchus. There was no evidence of the bleeding, leakage and inflammation. Subsequent course was uneventful. Tracheobronchial injuries related to the double-lumen endobronchial tube are discussed.
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Affiliation(s)
- Hyun Kyu Kim
- Department of Anesthesiology and Pain Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
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11
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Baranyai Z, Kocsis A, Jósa V. [Successful surgical treatment of tracheal rupture caused by endotracheal intubation]. Orv Hetil 2010; 151:946-9. [PMID: 20494890 DOI: 10.1556/oh.2010.28774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Rupture of the trachea is a rare complication of endotracheal intubation. The most common cause of the injury is the overinflation of the cuff. The authors present the case of a 45-year-old male in whom a 6 cm long trachea lesion was perceived during the operation due to a meso-hypopharyngeal tumor. Primary intervention resulted in successful reconstruction and full recovery. The case demonstrates the importance of prompt diagnosis and adequate therapy that helped in preventing an assumingly life-long complication or even death.
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Affiliation(s)
- Zsolt Baranyai
- Fovárosi Onkormányzat Uzsoki Utcai Kórház Sebészet-Ersebészeti Osztály Budapest Uzsoki u. 29. 1145.
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12
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Miñambres E, Burón J, Ballesteros MA, Llorca J, Muñoz P, González-Castro A. Tracheal rupture after endotracheal intubation: a literature systematic review. Eur J Cardiothorac Surg 2009; 35:1056-62. [DOI: 10.1016/j.ejcts.2009.01.053] [Citation(s) in RCA: 130] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2008] [Revised: 01/15/2009] [Accepted: 01/22/2009] [Indexed: 10/20/2022] Open
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13
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Seidl RO, Todt I, Westhofen M, Ernst A. Tracheal rupture in burns--a retrospective study. Burns 2007; 34:525-30. [PMID: 17928154 DOI: 10.1016/j.burns.2007.06.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2007] [Accepted: 06/24/2007] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Tracheal ruptures and tracheoesophageal injuries are rare, but life-threatening complications can arise during ventilation. METHOD A retrospective study of all burned patients placed on a ventilator between 2000 and 2005 (n=1693) identified two patients (0.1%) with a tracheal rupture and tracheoesophageal fistula (TOF). The diagnoses were confirmed using endoscopy and computed tomography. The tracheal and oesophageal defects were treated surgically immediately after diagnosis using a collar approach. RESULTS In all cases, withdrawal of ventilation proceeded without problems. Depending on their underlying condition, patients were transferred to normal wards with adequate spontaneous breathing and oral feeding. CONCLUSION Tracheal rupture and tracheoesophageal injury following orotracheal intubation is a rare complication in patients with burns (0.1% incidence). Following diagnosis, immediate surgical intervention is effective without further complications.
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Affiliation(s)
- Rainer O Seidl
- Department of Otolaryngology, Head and Neck Surgery at UKB, Free University of Berlin,Warener Strasse 7, D-12683 Berlin, Germany.
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Affiliation(s)
- Jay B Brodsky
- Department of Anesthesia, Stanford University School of Medicine, Stanford, CA 94305, USA.
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Ender J, Bury AM, Raumanns J, Schlünken S, Kiefer H, Bellinghausen W, Petry A. The use of a bronchial blocker compared with a double-lumen tube for single-lung ventilation during minimally invasive direct coronary artery bypass surgery. J Cardiothorac Vasc Anesth 2002; 16:452-5. [PMID: 12154424 DOI: 10.1053/jcan.2002.125144] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To investigate whether a bronchial blocker (BB) placed through a routinely used single-lumen tube (SLT) to achieve 1-lung ventilation is appropriate in patients undergoing a minimally invasive direct coronary artery bypass (MIDCAB) operation. DESIGN Clinical trial. SETTING University hospital. PARTICIPANTS Patients scheduled for elective MIDCAB operation (n = 159). INTERVENTIONS Group A was treated with a left-sided double-lumen tube (DLT) and served as the control group. Group B was intubated with a routinely used SLT in combination with a BB. MEASUREMENTS AND MAIN RESULTS The following data were collected: (1) time required for placement of each tube, (2) ventilation pressures, (3) lung compliance, (4) dislocations of the DLT or BB, (5) effectiveness of lung collapse, and (6) PaO(2) and fraction of inspired oxygen. In 4 patients (4%) of group B, the BB could not be placed within an acceptable time so that 155 patients (50 patients in group A, 105 patients in group B) were statistically analyzed. Statistically significant differences during 1-lung ventilation were found for peak and mean inspiratory pressure (p < 0.001 and p < 0.05), dynamic and static lung compliance (p < 0.05), and dynamic lung compliance change (p < 0.01). No statistical significance was found for intubation time (p > 0.05) and PaO(2) and fraction of inspired oxygen (p > 0.05). Lung collapse was insufficient in 1 patient of group A (2%) and in 2 patients of group B (2%). CONCLUSION To achieve 1-lung ventilation during a MIDCAB procedure, the use of a BB combined with an SLT is an appropriate technique as an alternative to the commonly used DLT.
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Affiliation(s)
- Jörg Ender
- Department of Anesthesia and Intensive Care II, Heart-center, University of Leipzig, Leipzig, Germany.
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Pandey CK, Singh N, Goyal P, Agarwal A. Tracheal injury during endoscopic hemithyroidectomy. J Laparoendosc Adv Surg Tech A 2001; 11:43-6. [PMID: 11444324 DOI: 10.1089/10926420150502940] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Unsuspected tracheal injury during endoscopic hemithyroidectomy is described. The diagnosis was delayed because of absent symptomatology. Surgical repair was planned but deferred because of infection. The patient was managed with a tracheostomy tube and antibiotics, and the wound healed completely without any residual abnormality or complications.
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Affiliation(s)
- C K Pandey
- Department of Anaesthesiology & Critical Care Medicine, SGPGIMS, Lucknow, India.
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Affiliation(s)
- B G Fitzmaurice
- Department of Anesthesiology, Stanford University School of Medicine, CA, USA
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Guyton DC, Besselievre TR, Devidas M, DeLima LG, Eichhorn JH. A comparison of two different bronchial cuff designs and four different bronchial cuff inflation methods. J Cardiothorac Vasc Anesth 1997; 11:599-603. [PMID: 9263093 DOI: 10.1016/s1053-0770(97)90012-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To compare directly measured pressures at the cuff/trachea interface that are associated with two different bronchial cuff designs and four different methods of bronchial cuff inflation suggested for use with one-lung ventilation. DESIGN In vitro study. SETTING Experimental laboratory in a university-affiliated hospital. INTERVENTIONS The bronchial cuffs of two different endotracheal tubes were inflated using one of four different methods of determining the cuff volume and pressure necessary to "just seal" the bronchus and obtain lung separation; positive-pressure test, negative-pressure test, CO2 analysis, and a new test using an anesthesia ventilator. When each method predicted the "just-seal" state, the pressure at the cuff/bronchus interface as well as cuff inflation pressure and volume were recorded. MEASUREMENTS AND MAIN RESULTS Although the new test was incompatible with the bronchial blocker, the other three tests all accurately predicted lung separation with the Univent, with no significant differences in pressures exerted on the trachea. However, when used with the double-lumen tube, the new test produced significantly lower measured parameters than the other inflation methods. CO2 analysis did not reliably predict bronchial seal with the double-lumen tube. CONCLUSIONS To achieve lung separation with the lowest pressure on the trachea, the new test is the most appropriate method for use with the double-lumen tube; however, the negative-pressure test appeared to be the easiest and fastest method for use with the bronchial blocker. Although the bronchial blocker was associated with lower pressures transmitted from the cuff to the trachea, the in vitro model cannot predict which bronchial cuff design would be superior in vivo.
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Affiliation(s)
- D C Guyton
- Department of Anesthesiology, University of Mississippi Medical Center, Jackson 39216-4505, USA
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García-Aguado R, Mateo EM, Onrubia VJ, Bolinches R. Use of the Univent System tube for difficult intubation and for achieving one-lung anaesthesia. Acta Anaesthesiol Scand 1996; 40:765-7. [PMID: 8836277 DOI: 10.1111/j.1399-6576.1996.tb04526.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND One-lung ventilation in major thoracic surgery is the most commonly accepted technique, not only for surgery on the lung but also in procedures involving the oesophagus, mediastinum and thoracic aorta. Conventional double-lumen tubes may sometimes be difficult to place correctly in patients in whom intubation is difficult. In such cases, the Univent System tube may be of help. It has a curved movable blocker of small calibre, and is designed to slide inside the bronchial tree and occlude all or part of the target lung. CASE REPORT We describe a new application of the Univent System tube in three cases where intubation was presumed to be difficult, and in another with unexpected difficult intubation. The laryngeal approach was carried out with the distally displaced blocker, inserting it through the sub-epiglottis or the posterior commissure visible orifice. The tube was firmly held and slid through the length of the blocker, rotating slowly until fully introduced. The advantages and criteria for its use are discussed. CONCLUSION Although the double-lumen tube is the first choice for one-lung ventilation, the Univent tube is a good option for selective bronchial intubation and in patients in whom difficult intubation is predicted.
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Affiliation(s)
- R García-Aguado
- Department of Anaesthesia, Hospital General Universitario, Valencia, Spain
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20
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Lieberman D, Littleford J, Horan T, Unruh H. Placement of left double-lumen endobronchial tubes with or without a stylet. Can J Anaesth 1996; 43:238-42. [PMID: 8829862 DOI: 10.1007/bf03011741] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
PURPOSE This study was designed to determine if leaving a stylet in the left Bronch-Cath endobronchial tube (DLT) for the entire intubating procedure improves the accuracy of placement on the initial attempt, without introducing complications. METHODS Sixty ASA 1-3 patients were randomized to one of two groups. In Group 1 (n = 30), the stylet was retained for the entire intubation procedure and in Group 2 (n = 30), the stylet was removed once the bronchial cuff had passed the vocal cords. In both groups, the DLT was turned 110 degrees counterclockwise and advanced until resistance was encountered. Placement was assessed by auscultation and fibreoptic bronchoscopy (FOB). After surgery, the DLT was replaced by a single-lumen endotracheal tube. The thoracic surgeon (blinded to the method of intubation, and using a FOB) assessed the appearance of the tracheobronchial mucosa. RESULTS The two groups were similar with respect to sex, height, weight, DLT size, surgeon and expertise of the laryngoscopist. When the stylet was retained, the DLT was correctly placed 60% of the time compared with 17%, if the stylet was removed, (P = 0.001). Seven out of 30 DLTs in Group 2 were initially placed into the right mainstem bronchus, (P = 0.005). The average time to confirmation of correct tube placement by FOB was increased in Group 2, (P = 0.01). Although the observed incidence of left bronchial, mucosal petechiae and erythema was greater in Group 2, this was not statistically significant, (P = 0.063). CONCLUSION Retaining the stylet for the entire intubation procedure allows for a more rapid, accurate placement of the DLT without increasing the incidence of tracheobronchial mucosa injury.
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Affiliation(s)
- D Lieberman
- Department of Anaesthesia, University of Manitoba, Health Sciences Centre, Winnipeg, Canada
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Abstract
BACKGROUND Tracheobronchial rupture after tracheal intubation has been infrequently reported. We report 6 cases of membranous tracheal rupture after endotracheal intubation treated at our institution over 7 years. METHODS Overinflation of the tracheal cuff was speculated to be a frequent cause of the tracheal damage because the lesion was always a linear laceration of the posterior membranous wall. The diagnosis was suspected on the basis of common signs such as subcutaneous emphysema, respiratory distress, pneumomediastinum, and pneumothorax. Fiberoptic bronchoscopy was the best means of confirming the diagnosis and determining the location and extent of the lesion. In 5 patients, extensive laceration with severe respiratory disorders required emergent repair through a right posterolateral thoracotomy. RESULTS There were two postoperative deaths unrelated to the tracheal lesion. A patient with a small tracheal defect and favorable clinical presentation showed a rapid positive outcome after conservative treatment. CONCLUSIONS Tracheal intubation-related airway ruptures are rare but probably underestimated. Early recognition and emergent repair are essential, because failure to do so could result in potentially lethal events.
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Affiliation(s)
- C H Marty-Ané
- Service de Chirurgie Thoracique, Hôpital Arnaud de Villeneuve, Centre Hospitalier Universitaire, Montpellier, France
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23
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Robinson RJ, Slinger P, Mulder DS, Shennib H, Benumof JL, Rehder K. Case 6--1994. Video-assisted thorascopic surgery using a single-lumen tube in spontaneously ventilating anesthetized patients: an alternative anesthetic technique. J Cardiothorac Vasc Anesth 1994; 8:693-8. [PMID: 7881003 DOI: 10.1016/1053-0770(94)90206-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- R J Robinson
- Department of Anaesthesia, Montreal General Hospital, Quebec, Canada
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Abstract
Over the years, thoracotomy has changed from a procedure that prompted major concern over cross-contamination caused by infection to pulmonary tumors. Assisting the thoracic surgeon by providing OLV is one of the most specialized skills an anesthesiologist can offer. This must be done in a safe, easy, and efficient manner. The Univent tube appears to be a hybrid, combining the best qualities of both the DLT and the single-lumen endotracheal tube with separate Fogarty-like catheter. The Univent tube is a technical improvement over separate endobronchial blocking catheters because its blocker shaft is attached to the main tube and, therefore, displacement is less likely. In addition, the Univent's axial blocker shaft has a lumen that provides for irrigation, suction, oxygen insufflation, CPAP, and HFV. Though equally as effective as the DLT in treatment of intraoperative hypoxemia, the Univent tube presents a unique advantage in the areas of aspiration prevention, prolonged intubation without tube exchange, and selective blockade of lung segments. The Univent tube is also easier to insert and has fewer associated risks compared to the DLT. Is it my purpose to suggest that because the Univent tube is equal to, or better than, the DLT in many areas, we should abandon the use of DLTs? Definitely not. Double-lumen tubes have performed well in the past and will continue to offer specialized functions, such as postoperative independent lung ventilation in single-lung transplant recipients. As with the acquisition of any new medical skill, the use of the Univent tube has a learning curve. It is worth the time and effort to learn to use the Univent tube.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- J M Gayes
- Department of Anesthesiology, Abbott Northwestern Hospital, Minneapolis, MN 55407
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