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Sheng B, Zhong L, Du B. Novel use of balloon-tipped bronchial blockers to occlude neonatal tracheoesophageal fistula: a case series. BMC Pediatr 2022; 22:60. [PMID: 35078431 PMCID: PMC8788077 DOI: 10.1186/s12887-022-03131-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 01/15/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Management of the airway and ventilation in neonates with a tracheoesophageal fistula (TEF) remains a significant challenge. The routine method of intubation involves placement of the tracheal tube tip beyond the fistula opening followed by isolation of the fistula from ventilation using the inflated cuff. When the fistula opening is close to the carina or below the level of the carina, the traditional technique is not suitable for adequate ventilation. Moreover, this method fails to prevent gastric insufflation.
Case presentation
We herein report a series of 10 newborns with TEFs (1,090–3,080 g) who underwent bronchoscopic insertion of a 5-Fr balloon-tipped bronchial blocker (BTBB) for temporary occlusion of the fistula. In seven newborns, placement of the BTBB was easily and quickly achieved with no incorrect placements. In addition, we successfully utilized the inner hollow cavity of the BTBB for gastric decompression in six neonates with severe gastric distension. However, three failed placements occurred in premature infants (<2,000 g) because the narrow cricoid cavity was too small to accommodate a 2.8-mm fiberoptic bronchoscope and a BTBB. The procedure was well tolerated by all infants, and no significant adverse events occurred.
Conclusions
Our findings illustrate that BTBBs can provide durable blockage of the fistula opening and should be considered as a treatment modality for infants with large carinal TEFs. Moreover, BTBB placement is neither arduous nor time-consuming. The hollow center, small round balloon, and 30-degree angled tip of the BTBB make this device feasible for clinical application, especially for neonates with severe gastrointestinal distension.
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Gupta B, Chaudhary K, Hayaran N, Neogi S. Anesthetic considerations in patients with cystic pulmonary adenomatoid malformations. J Anaesthesiol Clin Pharmacol 2021; 37:146-152. [PMID: 34349360 PMCID: PMC8289636 DOI: 10.4103/joacp.joacp_406_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 08/29/2020] [Accepted: 10/12/2020] [Indexed: 11/16/2022] Open
Abstract
Congenital pulmonary adenomatoid malformation (CPAM) is a rare entity. The authors searched the US National Library of Medicine Database, EMBASE, Google Scholar, PubMed Central for anesthetic management in CPAM. The search was performed using the terms: congenital cystic adenomatoid malformation, congenital pulmonary adenomatoid malformation, CCAM, CPAM, anesthetic management. The prognosis of CPAM depends on timely diagnosis, presence of hydrops, degree of hypoplasia of remaining lung, and the size of the lesion. Symptomatic patients must be treated surgically and lobectomy is considered the gold standard. Anesthetic management of such cases is challenging as it involves thoracotomy or thoracoscopic lobectomy or cystectomy and can lead to sudden hemodynamic Collapse. Early extubation should be considered to avoid iatrogenic ventilator-induced bronchial stump dehiscence resulting from positive pressure ventilation.
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Affiliation(s)
- Bhavna Gupta
- Department of Anaesthesia, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Kapil Chaudhary
- Department of Anaesthesia and Intensive Care, Maulana Azad Medical College, New Delhi, India
| | - Nitin Hayaran
- Department of Anaesthesia and Intensive Care, Lady Hardinge Medical College, New Delhi, India
| | - Sujoy Neogi
- Department of Paediatric Surgery, Maulana Azad Medical College, New Delhi, India
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Marraro GA. Selective bronchial intubation for one-lung ventilation and independent-lung ventilation in pediatric age: state of the art. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2020. [PMID: 32571450 DOI: 10.7499/j.issn.1008-8830.1912121] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Selective bronchial intubation (SBI) to ventilate a single lung (one-lung ventilation, OLV) or to apply separate lung ventilation (independent-lung ventilation, ILV) can be frequently required under general anesthesia in pediatrics, mainly in video assisted thoracoscopy surgery, in the postoperative care of cardio-thoracic surgery, and for the treatment of lung pathologies with unilateral prevalence in intensive care. In children over 6-8 years of age SBI, OLV and ILV can be performed using marketed double-lumen tubes (DLTs). In neonates, infants and younger children the application of ILV is limited due to the lack of DLTs. For children of this age, a specific DLT for ILV was developed (Marraro Paediatric Endobronchial Bilumen Tube®) but is currently available only as a special product. The DLT represents the device of choice for OLV and ILV while the use of bronchial blocker is suggested as an alternative to achieve the SBI and the OLV when suitable DLTs are not available. Different catheters types can be used as bronchial blocker. If SBI is not possible using DLT or bronchial blocker, a conventional single-lumen tube of adequate length can allow SBI in all pediatric ages. Using the bronchial blocker and single lumen tube it is possible to perform OLV but it is impossible to apply ILV. The main complications of SBI and DLT are largely due to limited operator experience. Airway trauma, dislodgment and obstruction of the devices are quite frequent and can lead to severe hypoxia if not recognized and treated early.
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Reference Values for Central Airway Dimensions on CT Images of Children and Adolescents. AJR Am J Roentgenol 2018; 210:423-430. [DOI: 10.2214/ajr.17.18597] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Gupta A, Gupta N. Ineffective Ventilation in A Neonate with A Large Pre-Carinal Tracheoesophageal Fistula and Bilateral Pneumonitis-Microcuff Endotracheal Tube to Our Rescue! J Neonatal Surg 2017; 6:14. [PMID: 28083500 PMCID: PMC5224747 DOI: 10.21699/jns.v6i1.410] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 06/24/2016] [Indexed: 12/03/2022] Open
Abstract
Tracheoesophageal fistula (TEF) is one of the most common congenital anomaly requiring surgical correction in neonatal period. The important goal of airway management is to avoid excessive gastric distension and ensure adequate ventilation prior to surgical ligation of the fistula. If a large fistula is present close to carina, excessive loss of delivered tidal volume may lead to ineffective ventilation. In addition, gastric distension elevates diaphragm and diminishes the lung compliance. If lung compliance is already impaired due to pre-existing lung pathology, situation becomes much more demanding. We report the successful airway management of a patient with large precarinal fistula and bilateral pneumonitis using the novel Microcuff tube. The unique design of microcuff makes it suitable to be used for this purpose. To the best of our knowledge, the use of microcuff ETT for perioperative airway management in case of a large precarinal fistula in a neonate with respiratory pathology has not been reported in the past.
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Affiliation(s)
- Anju Gupta
- Department of Anesthesiology, CNBC, Delhi, India
| | - Nishkarsh Gupta
- Department of Anesthesiology, DRBRAIRCH, All India Institute of Medical Sciences, New Delhi, India
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Murphy T, McCheyne A, Karlsson J. Analgesic management after thoracotomy for decortication in children: a retrospective audit of 83 children managed with a paravertebral infusion-based regime. Paediatr Anaesth 2016; 26:722-6. [PMID: 27146925 DOI: 10.1111/pan.12921] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/10/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND It is important that postoperative analgesic management after thoracotomy is very effective in order to optimize postoperative recovery. A regional technique such as an epidural or a paravertebral catheter with an infusion of local anesthetic may be supplemented with systemically administered analgesic drugs in order to achieve satisfactory analgesia. OBJECTIVE The objective of this observational study was to evaluate whether a paravertebral infusion of local anesthetic delivered via a surgically placed catheter together with systemic analgesics is associated with low pain scores and satisfactory analgesia after thoracotomy for decortication in children. METHODS We performed a retrospective analysis of the notes and charts of 83 children admitted with empyema thoracis and managed with thoracotomy and decortication. We collected data on the doses of analgesic drugs (morphine, paracetamol, and ibuprofen) and details of paravertebral infusions, together with postoperative pain scores for the first 48 h after surgery, or earlier if the paravertebral infusion was stopped within 48 h of surgery. Poor quality analgesia was defined as a score of 7 or more on the Visual Analog/Smiley Faces Scale ('VAS/SF'). RESULTS A total of 81 children were ASA 1 status and two were ASA 3 status. Analgesia comprised intravenous morphine at a mean dose of 20 μg·kg(-1) ·h(-1) , together with oral paracetamol (62.5 mg·kg(-1) /24 h) and ibuprofen (14.2 mg·kg(-1) /24 h). The mean paravertebral bupivacaine dose was 0.29 mg·kg(-1) ·h(-1) . Sixty-four patients (77.1%) had good quality analgesia, 17 (20.5%) patients had moderate quality analgesia, and only two patients (2.4%) had poor quality analgesia. CONCLUSION Analgesic outcomes with this regimen appear to be very satisfactory. It compares favorably with an epidural-based regimen.
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Affiliation(s)
- Tim Murphy
- Department of Paediatric Cardiothoracic Anaesthesia, Freeman Hospital, Newcastle Upon Tyne, UK
| | - Alan McCheyne
- Department of Paediatric Cardiothoracic Anaesthesia, Freeman Hospital, Newcastle Upon Tyne, UK
| | - Jacob Karlsson
- Department of Paediatric Cardiothoracic Anaesthesia, Freeman Hospital, Newcastle Upon Tyne, UK
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Chiluveru SA, Dave NM, Dias RJ, Garasia MB. Congenital pulmonary airway malformation with atrial septal defect and pulmonary hypertension for lobectomy-anesthetic considerations. Ann Card Anaesth 2016; 19:372-4. [PMID: 27052089 PMCID: PMC4900345 DOI: 10.4103/0971-9784.179624] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Accepted: 11/24/2016] [Indexed: 12/26/2022] Open
Abstract
The association of congenital pulmonary airway malformation (CPAM) with congenital heart disease is rare. We present the case of a 6-month-old child with atrial septal defect and pulmonary hypertension (PH) who presented with severe respiratory distress and hypoxia. The patient underwent right lobectomy for CPAM. With timely management, real-time monitoring, one lung ventilation, and adequate analgesia, we were able to extubate the child in the immediate postoperative period. We conclude that with meticulous planning and multidisciplinary team approach, such complex cases can be managed successfully.
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Affiliation(s)
- Swapna A. Chiluveru
- Department of Pediatric Anaesthesiology, Seth G.S. Medical College and K.E.M. Hospital, Parel, Mumbai, Maharashtra, India
| | - Nandini M. Dave
- Department of Pediatric Anaesthesiology, Seth G.S. Medical College and K.E.M. Hospital, Parel, Mumbai, Maharashtra, India
| | - Raylene J. Dias
- Department of Pediatric Anaesthesiology, Seth G.S. Medical College and K.E.M. Hospital, Parel, Mumbai, Maharashtra, India
| | - Madhu B. Garasia
- Department of Pediatric Anaesthesiology, Seth G.S. Medical College and K.E.M. Hospital, Parel, Mumbai, Maharashtra, India
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Respiratory strategies and airway management in patients with pulmonary alveolar proteinosis: a review. BIOMED RESEARCH INTERNATIONAL 2015; 2015:639543. [PMID: 26495308 PMCID: PMC4606191 DOI: 10.1155/2015/639543] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 07/21/2015] [Accepted: 07/27/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND Pulmonary alveolar proteinosis is a rare disorder characterized by a large accumulation of lipoproteinaceous material within the alveoli. This causes respiratory failure due to a restriction of gas exchange and changes in the ventilation/perfusion ratio. Treatment methods include noninvasive pharmacological approaches and invasive procedures, such as whole-lung lavage under general anesthesia. METHODS Based on the literature search using free-term key words, we have analyzed published articles concerning the perioperative management of adult and pediatric patients with pulmonary alveolar proteinosis. RESULTS AND DISCUSSION In total, 184 publications were analyzed. Only a few manuscripts were related to anesthetic, respiratory, and airway management in patients suffering from pulmonary alveolar proteinosis. Airway should be strictly separated using a double-lumen tube. Respiratory strategies involve the use of manual clapping, continuous positive airway pressure, high-frequency jet ventilation of the affected lung, and employment of venovenous extracorporeal membrane oxygenation in the most serious of cases. CONCLUSION The goal of this review is to summarize the current published information about an anesthetic management strategy with a focus on airway management, ventilation, and oxygenation techniques in PAP patients.
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Motshabi P. Anaesthesia for oesophageal atresia with or without tracheo-oesophageal atresia. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2014. [DOI: 10.1080/22201181.2014.979632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Hosking C, Motshabi-Chakane P. Thoracotomy in a spontaneously breathing neonate undergoing tracheo-oesophageal fistula repair. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2014. [DOI: 10.1080/22201173.2013.10872948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- C Hosking
- Department of Anaesthesia, Charlotte Maxeke Johannesburg Academic Hospital
| | - P Motshabi-Chakane
- Department of Anaesthesia, Charlotte Maxeke Johannesburg Academic Hospital
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Seok JH, Kim EJ, Ban JS, Lee SG, Lee JH, Seo DM, Shim KS. Severe desaturation while attempting one-lung ventilation for congenital cystic adenomatoid malformation with respiratory distress syndrome in neonate -A case report-. Korean J Anesthesiol 2013; 65:80-4. [PMID: 23904945 PMCID: PMC3726853 DOI: 10.4097/kjae.2013.65.1.80] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Revised: 09/04/2012] [Accepted: 09/05/2012] [Indexed: 11/25/2022] Open
Abstract
There are many methods for achieving one-lung ventilation (OLV) during thoracic surgery in neonates and the accuracy of OLV may affect postoperative outcome. The authors have performed OLV using a 5 Fr Arndt endobronchial blocker (AEB, Cook Inc., Bloomington, IN, USA) on a neonate diagnosed with congenital cystic adenomatoid malformation and respiratory distress syndrome (RDS) associated with marked mediastinal shift. In spite of sufficient preoxygenation, sudden and severe fall in oxygen saturation had occurred. Since neonates with RDS may develop sudden and severe desaturation, rapid intubation with anticipation of potential difficulty is necessary as well as sufficient preoxygenation.
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Affiliation(s)
- Ji-Hye Seok
- Department of Anesthesiology and Pain Medicine, Daegu Fatima Hospital, Daegu, Korea
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Cohen DE, McCloskey JJ, Motas D, Archer J, Flake AW. Fluoroscopic-assisted endobronchial intubation for single-lung ventilation in infants. Paediatr Anaesth 2011; 21:681-4. [PMID: 21492317 DOI: 10.1111/j.1460-9592.2011.03585.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Review our institutional experience with an alternative to fiberoptic-guided endobronchial intubation. AIM The aim of this retrospective cohort study was to present our experience with the use of fluoroscopy to facilitate endobronchial lung isolation in infants undergoing thoracoscopic procedures. BACKGROUND Anesthesiologists are more frequently being asked to anesthetize infants and small children for thoracoscopic surgery. Typically, endobronchial intubation or bronchial blockers are utilized to achieve lung isolation during these procedures. However, sometimes small and complicated anatomy can make this challenging. METHODS Respective chart review over a 13-month period of infants undergoing thoracoscopic excision of congenital lung lesions at the Children's Hospital of Philadelphia. Rate of success in achieving lung isolation along with time of fluoroscopy exposure were recorded. RESULTS Twenty infants had thoracoscopic lung surgery attempted during the period of the review. Lung isolation was successfully achieved in all of the patients. The average exposure to fluoroscopy was 83.7 s (range 20-320 s). CONCLUSIONS Fluoroscopic aided lung isolation is a reliable and effective alternative method to the use of fiberoptic bronchoscope for endobronchial intubation in infants.
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Affiliation(s)
- David E Cohen
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Hugh D, Cameron B. Anesthetic management of a neonate with a congenital cystic adenomatoid malformation and respiratory distress associated with gross mediastinal shift. Paediatr Anaesth 2009; 19:272-4. [PMID: 19236649 DOI: 10.1111/j.1460-9592.2008.02836.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Butkovic D, Kralik S, Matolic M, Kralik M, Toljan S, Radesic L. Postoperative analgesia with intravenous fentanyl PCA vs epidural block after thoracoscopic pectus excavatum repair in children. Br J Anaesth 2007; 98:677-81. [PMID: 17363405 DOI: 10.1093/bja/aem055] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The aim of this prospective, randomized trial was to compare analgesia, sedation, and cardiorespiratory function in children after thoracoscopic surgery for pectus excavatum repair, using two types of analgesia--epidural block with bupivacaine plus fentanyl vs patient-controlled analgesia (PCA) with fentanyl. METHODS Twenty-eight patients scheduled for thoracoscopic pectus excavatum surgery were randomly assigned to receive either thoracic epidural block or i.v. PCA for postoperative analgesia. Pain was assessed using a visual-analogue scale (VAS). The Ramsay sedation score, arterial pressure, ventilatory frequency, and heart rate were also measured, and blood gas analysis was performed regularly during the first 48 h after surgery. RESULTS A significant decrease in the VAS pain score, Ramsay sedation score, heart rate ventilatory frequency, systolic and diastolic blood pressure, and PaCO2, and a significant increase in PaO2 and oxygen saturation were found over time. Patients in the PCA group had significantly higher PaCO2 values. In addition, a significantly slower decline of systolic blood pressure and heart rate, and faster recovery of PaCO2 were found in PCA patients than in patients with epidural block. CONCLUSIONS I.V. fentanyl PCA is as effective as thoracic epidural for postoperative analgesia in children after thoracoscopic pectus excavatum repair. Bearing in mind the possible complications of epidural catheterization in children, the use of fentanyl PCA is recommended.
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Affiliation(s)
- D Butkovic
- Children's Hospital Zagreb, Department of Anaesthesiology, Reanimatology and Intensive Care, Zagreb, Croatia.
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Chengod S, Chandrasekharan AP, Manoj P. Selective left bronchial intubation and left-lung isolation in infants and toddlers: analysis of a new technique. J Cardiothorac Vasc Anesth 2006; 19:636-41. [PMID: 16202899 DOI: 10.1053/j.jvca.2004.10.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES The purpose of this study was to analyze and compare a new technique for left bronchial intubation and left-lung isolation in infants and toddlers without the help of bronchoscopes. METHODS In this prospective, unique comparative study, 3 different techniques for left mainstem bronchus intubation and left-lung isolation using a Fogarty catheter as a bronchial blocker were conducted in 11 children under age 4 who required left-lung isolation for left-lung surgery. A new technique for Fogarty catheter insertion and balloon inflation for proper positioning and avoiding displacement during lung handling was used. The first technique was a blind introduction to the left bronchus of the endotracheal tube (ETT) with the head turned to the right and the tube turned to the left at 180 degrees . The second one was to introduce the preshaped Fogarty catheter to the left bronchus. The third one was to intubate the left bronchus using the new technique of a preshaped ETT. RESULTS No left bronchial intubation could be achieved with the first technique. Left bronchial intubation and isolation were achieved in 2 of 11 by the second technique and 10 of 11 using the third technique. No bulb displacement occurred in any of these during lung handling. CONCLUSION The new technique of left bronchial intubation with a preshaped endotracheal tube was simple, safe, and easily accomplished. A Fogarty catheter can be positioned properly without the aid of a smaller bronchoscope once the left bronchus is intubated. Balloon displacement can be avoided completely if the left lung is collapsed properly and completely before the final balloon inflation.
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Affiliation(s)
- Suressh Chengod
- Department of Anesthesiology and Intensive Care, Division of Cardiothoracic and Vascular Anesthesiology and Intensive Care, Amrita Institute of Medical Sciences and Research Center, Cochin, Kerala, India.
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Guruswamy V, Roberts S, Arnold P, Potter F. Anaesthetic management of a neonate with congenital cyst adenoid malformation. Br J Anaesth 2005; 95:240-2. [PMID: 15964890 DOI: 10.1093/bja/aei171] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We report the anaesthetic management of a male neonate with congenital cyst adenoid malformation (CCAM) of the lung who underwent thoracotomy for resection of CCAM 24 h after birth and again at 24 days. The initial operation involved a 10-day admission to a paediatric intensive care unit (PICU) requiring ventilation, and was complicated by a pneumothorax. This report concentrates on the anaesthetic management for the second thoracotomy. The combination of intra-operative remifentanil infusion and the use of ultrasound to confirm correct placement of epidural catheter allowed on-table tracheal extubation and a shorter stay in PICU. The use of one-lung ventilation (OLV) allowed for better surgical access and enabled complete resection of the lesion.
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Affiliation(s)
- V Guruswamy
- Jackson Rees Department of Anaesthesia, The Royal Liverpool Children's Hospital NHS Trust, Alder Hey, Eaton Road, Liverpool L12 2AP, UK.
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