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Jha RR, Mishra S, Bhatnagar S. Rupture of Left Main Bronchus Associated with Radiotherapy-induced Bronchial Injury and Use of a Double-lumen Tube in Oesophageal Cancer Surgery. Anaesth Intensive Care 2019; 32:104-7. [PMID: 15058130 DOI: 10.1177/0310057x0403200117] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We report a case of rupture of the left main bronchus in a female patient with oesophageal carcinoma, who had received thoracic radiotherapy preoperatively. Endotracheal intubation was achieved with a left-sided double-lumen tube. After almost three hours of intubation and one and half hours of one-lung ventilation, bronchial injury was detected. Immediate surgical repair of the membranous part of the bronchus was undertaken, as well as completion of the oesophagectomy. Radiotherapy-induced damage to the bronchus was thought to have contributed to the rupture. The presentation, diagnosis and management of intraoperative bronchial rupture are discussed.
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Affiliation(s)
- R R Jha
- Department of Anesthesiology, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
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2
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Featherstone PJ, Westhorpe RN, Ball CM. Anaesthesia for Thoracic Surgery 4. Anaesth Intensive Care 2019; 42:283-4. [DOI: 10.1177/0310057x1404200301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Sinha PK, Misra S, Unnikrishnan M, Bhuyan RR. Horseshoe lung secondary to hypoplastic left lung for pneumonectomy. J Cardiothorac Vasc Anesth 2007; 21:250-2. [PMID: 17418741 DOI: 10.1053/j.jvca.2006.07.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2005] [Indexed: 11/11/2022]
Affiliation(s)
- Prabhat Kumar Sinha
- Department of Anaesthesiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Kerala, India.
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Urschel HC. History of general thoracic surgery and the Southern Thoracic Surgical Association: the first 25 years. Ann Thorac Surg 2003; 76:S11-3. [PMID: 14596977 DOI: 10.1016/s0003-4975(03)01495-4] [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] [Indexed: 11/15/2022]
Affiliation(s)
- Harold C Urschel
- Cardiovascular and Thoracic Surgical Research, Education and Clinical Excellence, Baylor University Medical Center, Dallas, Texas 75246, USA.
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Abstract
PURPOSE Placement of double lumen tubes (DLTs) in both normal and difficult airways may be considerably more difficult than standard laryngoscopy and intubation using standard tracheal tubes. Alternative techniques to place DLTs have not been uniformly successful and alternative tracheal tubes do not provide the versatility afforded by the DLT. We intubated the tracheas of patients undergoing thoracic procedures requiring DLTs with the Bullard laryngoscope (BL) to determine its efficacy and outline its shortcomings. METHODS Twenty nine consecutive patients scheduled for general anesthesia requiring DLT were evaluated. The laryngeal view, time to intubation and the reason for any difficulty with intubation were recorded. Any patient who required a second DLT placement had the second attempt performed via standard laryngoscopy. RESULTS The time to laryngoscopy was 9+/-5 sec, and the time to intubation was 28+/-10 sec. All patients had Cormack scores of grade of 1 through the BL. The placement of the bronchial lumen of the DLT was found to be in the correct location (left mainstem bronchus) in 9 of 28 patients. CONCLUSION The BL appears to be effective in the placing DLT into the trachea of patients.
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Affiliation(s)
- G B Shulman
- Department of Anesthesiology, Baystate Medical Center, Tufts University School of Medicine, Springfield, MA 01199, USA
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6
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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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Cohen E, Neustein SM, Goldofsky S, Camunas JL. Incidence of malposition of polyvinylchloride and red rubber left-sided double-lumen tubes and clinical sequelae. J Cardiothorac Vasc Anesth 1995; 9:122-7. [PMID: 7780066 DOI: 10.1016/s1053-0770(05)80181-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Currently, fiberoptic bronchoscopy (FB) is recommended for correct positioning of double-lumen endobronchial tubes (DLTs) because of the high incidence of malpositions not appreciated by clinical signs. The aims of this study were to assess whether clinical signs allow accurate confirmation of adequate positioning with left red rubber (RR) or polyvinyl-chloride (PVC) double-lumen tubes and to compare the incidence of malpositions between the two tubes. Another goal was to assess whether these malpositions, not appreciated by clinical assessment, adversely affected outcome. Twenty-one adult patients scheduled for elective thoracic surgery were randomly assigned to the RR (11 patients) or PVC group (10 patients). After endobronchial intubation, the position of the tubes was adjusted until clinically satisfactory lung separation had been achieved. A single investigator performed all the FB assessments were performed in the supine (SUP) and lateral positions. The anesthesiologists responsible for the clinical evaluation were "blinded" to the bronchoscopic findings. While in the SUP position, the tube was "too deep" to permit visualization of the carina during tracheal bronchoscopy in 5 patients (2 RR, 3 PVC). In 17 of 21 (10 RR, 7 PVC), the bronchial cuff could not be visualized, although in 1 patient (RR group), the cuff was overinflated and bulged out to partially obstruct the right main bronchus orifice. Bronchial bronchoscopy showed 4 of 11 patients in the RR group in whom the left upper lobe orifice was occluded compared with 1 only in the PVC group.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- E Cohen
- Department of Anesthesiology, Mount Sinai Medical Center, New York, NY 10029-6574, USA
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9
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Conacher ID, Herrema IH, Batchelor AM. Robertshaw double lumen tubes: a reappraisal thirty years on. Anaesth Intensive Care 1994; 22:179-83. [PMID: 8210022 DOI: 10.1177/0310057x9402200211] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
A prospective analysis of 100 successive intubations with Robertshaw tubes in patients submitted for routine thoracic surgery is presented. Clinical guidelines for intubation were used as the protocol. Tube position was judged on clinical assessment only and not confirmed with fibreoptic bronchoscopy. In approximately 60% of cases the tubes were judged to be correctly placed on initial introduction. In 20-30% of cases, minor and simple adjustments were required to achieve suitable conditions for one lung anaesthesia. In no case did it prove impossible to achieve conditions adequate for surgery. Common problems related to the endobronchial portion of tubes entering the wrong bronchus, being inserted too far, or not far enough. Two of six episodes of hypoxaemia related to minor problems with tubes and were easily corrected. The experience is compared with that of other workers. The pertinence and implications of the experience and the data to the training of personnel in the techniques of one-lung ventilation and the future of Robertshaw tubes are discussed. It is concluded that the good practical results achieved are specifically related to the Robertshaw design and the material of manufacture.
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Affiliation(s)
- I D Conacher
- Department of Cardiothoracic Anaesthesia, Freeman Hospitals Trust, Newcastle-upon-Tyne, England
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Abstract
With the advent of laparoscopic techniques for application in the chest, as well as the development of new video equipment and instrumentation technology, the cardiothoracic surgeon can now perform procedures that, until very recently, were performed only by thoracotomy. Modern thoracoscopy has not reached its final resolution, but a growing number of procedures have been performed that permit some initial recommendations to be made and that define areas of research for the anesthesiologist. A review of the physiology of the lateral decubitus position will act as a basis for developing rational decisions concerning the conduction of anesthesia for thoracoscopy. Future research and experience in thoracoscopy will help to further define appropriate anesthetic techniques.
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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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Slinger P, Suissa S, Triolet W. Predicting arterial oxygenation during one-lung anaesthesia. Can J Anaesth 1992; 39:1030-5. [PMID: 1464128 DOI: 10.1007/bf03008370] [Citation(s) in RCA: 77] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Eighty patients undergoing elective thoracotomy were studied to assess the possibility of predicting arterial oxygenation (PaO2) during one-lung anaesthesia (OLA). The first 50 patients were studied retrospectively. The method of multiple linear regression was used to construct a predictive equation for PaO2 during OLA. Potential predictors of PaO2 during OLA which were considered were: age, side of operation, preoperative pulmonary flow rates, preoperative and intraoperative PaO2 during two-lung ventilation. The three most significant predictors for PaO2 during OLA were: side right of operation (P < 0.05), preoperative FEV1% (P < 0.01) and intraoperative PaO2 during two-lung ventilation (P = 0.0001). The predictive equation for PaO2 after ten minutes of OLA was: PaO2 = 100 - 72 (side) - 1.86 (FEV1%) + 0.75 (two-lung) PaO2; (for side insert 0 for left-sided thoracotomy and 1 for right-sided thoracotomy). The remaining 30 patients were studied prospectively and the predicted PaO2 correlated with the observed PaO2 after ten minutes of OLA (r = 0.73, P < 0.01). Four of 30 patients had a predicted PaO2 at ten minutes of OLA < 150 mmHg. Of these, 2/4 subsequently required abandonment of OLA for pulse oximetric saturation < 85%. We conclude that although it is not possible to predict an individual patient's PaO2 during OLA with a high degree of accuracy, it is possible, before the initiation of OLA, to identify those patients whose arterial oxygenation is likely to decrease to low levels during OLA.
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Affiliation(s)
- P Slinger
- Department of Anaesthesia, McGill University, Montreal, Quebec, Canada
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Brodsky JB. Clinical separation of the lungs. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 1992; 11:178-92. [PMID: 1503292 DOI: 10.1016/s0750-7658(05)80011-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- J B Brodsky
- Stanford University Medical Center, California 94305
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Pro: proper positioning of a double-lumen endobronchial tube can only be accomplished with endoscopy. JOURNAL OF CARDIOTHORACIC ANESTHESIA 1988; 2:101-4. [PMID: 2979123 DOI: 10.1016/0888-6296(88)90154-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Sibai AN, Baraka A. A new double lumen tube adaptor. Use in adjustment of bronchial cuff volume and oxygenation. Anaesthesia 1986; 41:628-30. [PMID: 3728934 DOI: 10.1111/j.1365-2044.1986.tb13057.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The report describes a new double lumen tube adaptor which provides selective one lung ventilation without external clamping. It also facilitates, without disconnexion and remantling, both correct bronchial cuff inflation and continuous positive airway pressure administration using an underwater seal chest bottle. Oxygenation can be kept optimal during one lung anaesthesia by applying 1.0 kPa continuous positive airway pressure to the nonventilated lung using an oxygen flow of 1-2 litres/minute.
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Burton NA, Watson DC, Brodsky JB, Mark JB. Advantages of a new polyvinyl chloride double-lumen tube in thoracic surgery. Ann Thorac Surg 1983; 36:78-84. [PMID: 6860029 DOI: 10.1016/s0003-4975(10)60655-8] [Citation(s) in RCA: 66] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Double-lumen endobronchial tubes offer many advantages during thoracic operations. However, technical problems with tube placement and potentially life-threatening complications have discouraged widespread use of standard double-lumen tubes. Some of these problems may be reduced with a new polyvinyl chloride (PVC) double-lumen tube. A total of 214 intubations were undertaken in 204 patients using one of three endobronchial tubes. The cases of these patients were reviewed to determine differences in the complications associated with the Carlens, Robertshaw, and PVC tubes. Complications included unsuccessful or difficult intubation, tube dislodgment, unsatisfactory lung deflation, tube malposition, and hypoxemia. In 8 of 16 intubations with the Carlens tube and in 14 of 62 intubations with the Robertshaw tube, there were complications. In all, 22 of 78 intubations (28%) using conventional double-lumen tubes were complicated compared with 5 of 136 (4%) using the PVC tube. The technical problems and risks of endobronchial intubation were reduced significantly with the PVC double-lumen tube.
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Peltola K. Central haemodynamics and oxygenation during thoracic anaesthesia. ACTA ANAESTHESIOLOGICA SCANDINAVICA. SUPPLEMENTUM 1983; 77:1-51. [PMID: 6576594 DOI: 10.1111/j.1399-6576.1983.tb01999.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Burton NA, Fall SM, Lyons T, Graeber GM. Rupture of the left main-stem bronchus with a polyvinylchloride double-lumen tube. Chest 1983; 83:928-9. [PMID: 6851700 DOI: 10.1378/chest.83.6.928] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Double-lumen tubes have proved to be a useful adjunct in thoracic surgery. Their use has become quite commonplace, particularly since the introduction of the softer polyvinylchloride (PVC) tubes, which are technically easier to use and may carry less risk for serious complications. Any such tube, however, can cause life-threatening complications. We present a case with such a complication related to the use of a PVC double-lumen tube and make recommendations regarding the use of these tubes to minimize the risk of serious intraoperative complications.
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Abstract
Two cases are described in which problems with double lumen bronchial tubes occurred during thoracic surgery. A urinary catheter inserted down one lumen of each of the tubes enabled one lung anaesthesia to be continued without disturbing the surgery. This technique should be considered before abandoning one lung anaesthesia in those few cases where double lumen tubes fail to function as desired.
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Fiser WP, Friday CD, Read RC. Changes in arterial oxygenation and pulmonary shunt during thoracotomy with endobronchial anesthesia. J Thorac Cardiovasc Surg 1982. [DOI: 10.1016/s0022-5223(19)37240-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Harrison GA, Kelly AJ. Technical aspects of bronchopulmonary lavage for alveolar proteinosis: two case reports. Anaesth Intensive Care 1981; 9:277-85. [PMID: 6792945 DOI: 10.1177/0310057x8100900313] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Under general anaesthesia, therapeutic bronchopulmonary lavage was performed in two patients suffering from alveolar proteinosis. In one patient, difficulties were experienced during attempted lavage of the right lung. Fluid trapping occurred when saline was infused down the tracheal (right) lumen of a Carlen's double lumen endobronchial tube and also when a left Robertshaw tube was similarly used. Spillover of saline into the left lung occurred when a right Robertshaw was used. Efficient lavage of the right lung could only be performed after insertion of a White endobronchial tube. In the second patient, both lungs were washed without problem using a left Robertshaw tube after difficulty had been experienced with a Carlen's tube. In both cases venous admixture was least when the lavaged lung was filled with saline. Hypoxaemia increased as the lung was drained. Details of technique are discussed as are problems with double lumen endobronchial tubes used during the procedure.
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