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Ji G, Zhang H, Liu X, Li J. Airway rupture caused by the polyvinylchloride double-lumen tube-A case report. Asian J Surg 2024; 47:3773-3774. [PMID: 38714413 DOI: 10.1016/j.asjsur.2024.04.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 04/18/2024] [Indexed: 05/09/2024] Open
Affiliation(s)
- Guoyu Ji
- Department of Anesthesiology, The Affiliated Hospital of Cheng de Medical University, Chengde, Hebei, China
| | - Huanhuan Zhang
- Department of Anesthesiology, The Affiliated Hospital of Cheng de Medical University, Chengde, Hebei, China
| | - Xiulan Liu
- Department of Anesthesiology, The Affiliated Hospital of Cheng de Medical University, Chengde, Hebei, China
| | - Jianling Li
- Department of Anesthesiology, The Affiliated Hospital of Cheng de Medical University, Chengde, Hebei, China.
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2
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Baek J, Park SJ, Seo M, Choi EK. Unexpected Tension Pneumothorax after Double-Lumen Endotracheal Intubation in Patients with Pulmonary Edema: A Case Report. Medicina (B Aires) 2023; 59:medicina59030460. [PMID: 36984461 PMCID: PMC10058528 DOI: 10.3390/medicina59030460] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 02/01/2023] [Accepted: 02/22/2023] [Indexed: 03/03/2023] Open
Abstract
Tension pneumothorax is a relatively rare complication after anesthetic induction that requires prompt diagnosis and treatment. Several handling errors related to intubation procedures or equipment and vigorous positive pressure ventilation are potentially important etiologies of tension pneumothorax in patients with underlying lung disease or in mechanically ventilated patients. We describe a case of tension pneumothorax observed after double-lumen tube (DLT) insertion followed by single-lumen tube replacement using an airway exchanger catheter in a mechanically ventilated patient. An 84-year-old female on mechanical ventilation underwent minimally invasive cardiac surgery under general anesthesia. Immediately after left-sided DLT insertion using an airway exchanger catheter, oxygen saturation decreased to 89%, peak airway pressure increased to 35 cm H2O with inadequate tidal volume, and blood pressure gradually dropped to 69/41 mmHg. Breath sounds from the right hemithorax were significantly reduced. Severe collapse of the right lung, a flattened diaphragm, and compressed abdominal organs were identified on chest radiography. Therefore, a tube thoracotomy was performed based on the findings of a tension pneumothorax. Then, oxygen saturation, peak airway pressure with adequate tidal volume, and blood pressure improved, and the distended abdomen normalized. After the pneumothorax resolved, a bronchoscopy was performed. Slight redness was noted in the right bronchus, indicating that the DLT was incorrectly inserted into the right side. In conclusion, the possibility of a tension pneumothorax should be considered during DLT intubation or endotracheal tube replacement with an airway exchange catheter.
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3
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Liu W, Jin F, Wang HM, Yong FF, Wu Z, Jia HQ. The association between double-lumen tube versus bronchial blocker and postoperative pulmonary complications in patients after lung cancer surgery. Front Oncol 2022; 12:1011849. [PMID: 36237329 PMCID: PMC9552823 DOI: 10.3389/fonc.2022.1011849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 09/13/2022] [Indexed: 12/02/2022] Open
Abstract
Background Both double-lumen tube (DLT) and bronchial blocker (BB) are used for lung isolation in patients undergoing lung cancer surgery. However, the effects of different devices for lung isolation remain inconclusive. Present study was designed to investigate the association between the choice of the two devices and postoperative pulmonary complications (PPCs) in patients with lung cancer. Methods In this retrospective cohort study, patients who underwent lung cancer surgery between January 1, 2020 and October 31, 2020 were screened. Patients were divided into two groups according to different devices for lung isolation: DLT group and BB group. Primary outcome was the incidence of a composite of PPCs during postoperative in-hospital stay. Results A total of 1721 were enrolled for analysis, of them, 868 received DLT and 853 BB. A composite of PPCs was less common in patients with BB (25.1%, [214/853]) than those received DLT (37.9% [329/868] OR 0.582 95% CI 0.461-0.735 P < 0.001). Respiratory infection was less common in BB group (14.4%, [123/853]) than DLT group (30.3%, [263/868], P<0.001). The incidence of non-PPCs complications was not statistically significant between the 2 groups. Conclusions For patients undergoing surgery for lung cancer, the use of BB for lung isolation was associated with a reduced risk of PPCs when compared with DLT.
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Affiliation(s)
- Wei Liu
- Department of Anesthesiology, The Forth hospital of Hebei Medical University, Shijiazhuang, China
| | - Fan Jin
- Department of Anesthesiology, Zhuji People’s Hospital, Shaoxing, China
| | - He-Mei Wang
- Department of Anesthesiology, The Forth hospital of Hebei Medical University, Shijiazhuang, China
| | - Fang-Fang Yong
- Department of Anesthesiology, The Forth hospital of Hebei Medical University, Shijiazhuang, China
| | - Zhen Wu
- Department of Anesthesiology, The Forth hospital of Hebei Medical University, Shijiazhuang, China
| | - Hui-Qun Jia
- Department of Anesthesiology, The Forth hospital of Hebei Medical University, Shijiazhuang, China
- *Correspondence: Hui-Qun Jia,
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4
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Hsu HT, Kuo YW, Ma CW, Su MP, Tseng KY, Li CL, Cheng KI. Trachway® flexible stylet facilitates the correct placement of double-lumen endobronchial tube: a prospective, randomized study. BMC Anesthesiol 2022; 22:260. [PMID: 35971080 PMCID: PMC9377073 DOI: 10.1186/s12871-022-01800-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 08/04/2022] [Indexed: 11/10/2022] Open
Abstract
Background The mainstream facilitation of one-lung ventilation is using double-lumen endobronchial tubes. However, it is more difficult to be positioned properly and more likely to cause airway injuries. How to place double-lumen endobronchial tubes rapidly and correctly is important for thoracic anesthesiologists. Methods One hundred eight patients with an American Society of Anesthesiologists physical status of I to III were 20 years of age or over, and required one-lung ventilation for thoracic surgery. They were randomly assigned to the conventional technique group (n = 36), the flexible fiberoptic bronchoscopy group (n = 36), or the Trachway® flexible stylet group (n = 36). The primary endpoint was the time needed for intubation. T1, the time from the tip of the blade passing between the patient’s lips to identification of the vocal cords; and T2, the time from identification of the vocal cords to the bronchial lumen was in the correct position. Results T1 had no significant difference between groups, but T2 was significantly shorter in the Trachway® flexible stylet group (p < 0.0001) and longer in the conventional technique group (p < 0.0001). Conclusions Using Trachway® flexible stylet for correct placement of double-lumen endobronchial tubes not only significantly shortened the intubation time, but also reduced incidence of carinal injuries. It is an alternative, and a choice with good safety. Trial registration ClinicalTrials.gov Identifier: NCT02364622, 18/02/2015, Retrospectively registered. Supplementary Information The online version contains supplementary material available at 10.1186/s12871-022-01800-8.
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Affiliation(s)
- Hung-Te Hsu
- Department of Anesthesiology, Kaohsiung Medical University Chung-Ho Memorial Hospital, No.100, Tzyou 1st Rd., Sanmin Dist., 80756, Kaohsiung City, Taiwan (R.O.C.).,Department of Anesthesiology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yi-Wei Kuo
- Department of Anesthesiology, Kaohsiung Medical University Chung-Ho Memorial Hospital, No.100, Tzyou 1st Rd., Sanmin Dist., 80756, Kaohsiung City, Taiwan (R.O.C.)
| | - Chao-Wei Ma
- Department of Anesthesiology, Kaohsiung Medical University Chung-Ho Memorial Hospital, No.100, Tzyou 1st Rd., Sanmin Dist., 80756, Kaohsiung City, Taiwan (R.O.C.).
| | - Miao-Pei Su
- Department of Anesthesiology, Kaohsiung Medical University Chung-Ho Memorial Hospital, No.100, Tzyou 1st Rd., Sanmin Dist., 80756, Kaohsiung City, Taiwan (R.O.C.)
| | - Kuang-Yi Tseng
- Department of Anesthesiology, Kaohsiung Medical University Chung-Ho Memorial Hospital, No.100, Tzyou 1st Rd., Sanmin Dist., 80756, Kaohsiung City, Taiwan (R.O.C.)
| | - Chin-Ling Li
- Department of Anesthesiology, Kaohsiung Medical University Chung-Ho Memorial Hospital, No.100, Tzyou 1st Rd., Sanmin Dist., 80756, Kaohsiung City, Taiwan (R.O.C.)
| | - Kuang-I Cheng
- Department of Anesthesiology, Kaohsiung Medical University Chung-Ho Memorial Hospital, No.100, Tzyou 1st Rd., Sanmin Dist., 80756, Kaohsiung City, Taiwan (R.O.C.).,Department of Anesthesiology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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5
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Risse J, Szeder K, Schubert AK, Wiesmann T, Dinges HC, Feldmann C, Wulf H, Meggiolaro KM. Comparison of left double lumen tube and y-shaped and double-ended bronchial blocker for one lung ventilation in thoracic surgery—a randomised controlled clinical trial. BMC Anesthesiol 2022; 22:92. [PMID: 35366801 PMCID: PMC8976407 DOI: 10.1186/s12871-022-01637-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 03/25/2022] [Indexed: 11/10/2022] Open
Abstract
Background Double lumen tube (DLT) intubation is the most commonly used technique for one lung ventilation. Bronchial blockers (BB) are an alternative, especially for difficult airways. The EZ-bronchial blocker (EZB) is an innovative y-shaped and double-ended device of the BB family. Methods A randomised, controlled trial was conducted in 80 patients undergoing elective thoracic surgery using DLT or EZB for one lung ventilation (German Clinical Trial Register DRKS00014816). The objective of the study was to compare the clinical performance of EZB with DLT. Primary endpoint was total time to obtain successful one lung ventilation. Secondary endpoints were time subsections, quality of lung collapse, difficulty of intubation, any complications during the procedure, incidence of objective trauma of the oropharynx and supraglottic space and intubation-related subjective symptoms. Results 74 patients were included, DLT group (n = 38), EZB group (n = 36). Median total time to obtain one lung ventilation [IQR] in the DLT group was 234 s [207 to 294] versus 298 s [243 to 369] in the EZB group (P = 0.007). Median total time was relevantly influenced by different preparation times. Quality of lung collapse was equal in both groups, DLT group 89.5% were excellent vs. 83.3% in the EZB group (P = 0.444). Inadequate lung collapse in five patients of the EZB group resulted in unsuccessful repositioning attempts and secondary DLT placement. Endoscopic examinations revealed significantly more carina trauma (P = 0.047) and subglottic haemorrhage (P = 0.047) in the DLT group. Postoperative subjective symptoms (sore throat, hoarseness) were more common in the DLT group, as were speech problems. Conclusions Using EZB prima facie results in prolonged time to obtain one lung ventilation with equal quality of lung collapse for the thoracic surgeon. If preparation times are omitted in the analysis, the time difference is statistically and clinically not relevant. Our data showed only little evidence for reducing objective airway trauma as well as subjective complaints. In summary both procedures were comparable in terms of times and clinical applicability. Therefore decisions for DLT or EZB should depend more on individual experience, in-house equipment and the individual patient, than on any times that are neither clinically significant nor relevant. Trial registration German Clinical Trial Register DRKS00014816, prospectively registered on 07.06.2018
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Karczewska K, Bialka S, Smereka J, Cyran M, Nowak-Starz G, Chmielewski J, Pruc M, Wieczorek P, Peacock FW, Ladny JR, Szarpak L. Efficacy and Safety of Video-Laryngoscopy versus Direct Laryngoscopy for Double-Lumen Endotracheal Intubation: A Systematic Review and Meta-Analysis. J Clin Med 2021; 10:jcm10235524. [PMID: 34884226 PMCID: PMC8658072 DOI: 10.3390/jcm10235524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 11/22/2021] [Accepted: 11/24/2021] [Indexed: 11/24/2022] Open
Abstract
The available meta-analyses have inconclusively indicated the advantages of video-laryngoscopy (VL) in different clinical situations; therefore, we conducted a systematic review and meta-analysis to determine efficacy outcomes such as successful first attempt or time to perform endotracheal intubation as well as adverse events of VL vs. direct laryngoscopes (DL) for double-lumen intubation. First intubation attempt success rate was 87.9% for VL and 84.5% for DL (OR = 1.64; 95% CI: 0.95 to 2.86; I2 = 61%; p = 0.08). Overall success rate was 99.8% for VL and 98.8% for DL, respectively (OR = 3.89; 95%CI: 0.95 to 15.93; I2 = 0; p = 0.06). Intubation time for VL was 43.4 ± 30.4 s compared to 54.0 ± 56.3 s for DL (MD = −11.87; 95%CI: −17.06 to −6.68; I2 = 99%; p < 0.001). Glottic view based on Cormack–Lehane grades 1 or 2 equaled 93.1% and 88.1% in the VL and DL groups, respectively (OR = 3.33; 95% CI: 1.18 to 9.41; I2 = 63%; p = 0.02). External laryngeal manipulation was needed in 18.4% cases of VL compared with 42.8% for DL (OR = 0.28; 95% CI: 0.20 to 0.40; I2 = 69%; p < 0.001). For double-lumen intubation, VL offers shorter intubation time, better glottic view based on Cormack–Lehane grade, and a lower need for ELM, but comparable first intubation attempt success rate and overall intubation success rate compared with DL.
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Affiliation(s)
- Katarzyna Karczewska
- Department of Anesthesiology, Masovian Specialist Hospital, 26-617 Radom, Poland;
| | - Szymon Bialka
- Department of Anesthesiology and Intensive Care, Medical University of Silesia, 41-800 Zabrze, Poland;
| | - Jacek Smereka
- Department of Emergency Medical Service, Wroclaw Medical University, 51-618 Wroclaw, Poland;
- Research Unit, Polish Society of Disaster Medicine, 05-806 Warszawa, Poland; (M.C.); (M.P.); (P.W.)
| | - Maciej Cyran
- Research Unit, Polish Society of Disaster Medicine, 05-806 Warszawa, Poland; (M.C.); (M.P.); (P.W.)
- Institute of Outcomes Research, Maria Sklodowska-Curie Medical Academy, 03-411 Warsaw, Poland
| | - Grazyna Nowak-Starz
- Institute of Health Sciences, Jan Kochanowski University of Kielce, 25-369 Kielce, Poland;
| | | | - Michal Pruc
- Research Unit, Polish Society of Disaster Medicine, 05-806 Warszawa, Poland; (M.C.); (M.P.); (P.W.)
| | - Pawel Wieczorek
- Research Unit, Polish Society of Disaster Medicine, 05-806 Warszawa, Poland; (M.C.); (M.P.); (P.W.)
- Research Unit, Polonia University, 42-200 Czestochowa, Poland
| | - Frank William Peacock
- Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine, Houston, TX 77030, USA;
| | - Jerzy Robert Ladny
- Department of Emergency Medicine, Bialystok Medical University, 15-295 Bialystok, Poland;
| | - Lukasz Szarpak
- Research Unit, Polish Society of Disaster Medicine, 05-806 Warszawa, Poland; (M.C.); (M.P.); (P.W.)
- Research Unit, Maria Sklodowska-Curie Bialystok Oncology Center, 15-027 Bialystok, Poland
- Correspondence: ; Tel.: +48-500-186-225
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7
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Oo S, Chia RHX, Li Y, Sampath HK, Ang SBL, Paranjothy S, Tam JKC, Lee CCM. Bronchial rupture following endobronchial blocker placement: a case report of a rare, unfortunate complication. BMC Anesthesiol 2021; 21:208. [PMID: 34461826 PMCID: PMC8404020 DOI: 10.1186/s12871-021-01430-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 08/20/2021] [Indexed: 11/23/2022] Open
Abstract
Background Lung separation may be achieved through the use of double lumen tubes or endobronchial blockers. The use of lung separation techniques carries the risk of airway injuries which range from minor complications like postoperative hoarseness and sore throat to rare and potentially devastating tracheobronchial mucosal injuries like bronchus perforation or rupture. With few case reports to date, bronchial rupture with the use of endobronchial blockers is indeed an overlooked complication. Case presentation A 78-year-old male patient with a left upper lobe lung adenocarcinoma underwent a left upper lobectomy with a Fuji Uniblocker® as the lung separation device. Despite an atraumatic insertion and endobronchial blocker balloon volume within manufacturer specifications, an intraoperative air leak developed, and the patient was found to have sustained a left mainstem bronchus rupture which was successfully repaired and the patient extubated uneventfully. Unfortunately, the patient passed on in-hospital from sepsis and other complications. Conclusion Bronchial rupture is a serious complication of endobronchial blocker use that can carry significant morbidity, and due care should be exercised in its use and placement. Bronchoscopy should be used during insertion, and the volume and pressure of the balloon kept to the minimum required to prevent air leak. Bronchial injury should be considered as a differential in the presence of an unexplained air leak. Supplementary Information The online version contains supplementary material available at 10.1186/s12871-021-01430-6.
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Affiliation(s)
- Shuwen Oo
- Department of Anaesthesia, National University Health System, Singapore, Singapore.
| | - Rachel Hui Xuan Chia
- Department of Anaesthesia, National University Health System, Singapore, Singapore
| | - Yue Li
- Department of Cardiothoracic and Vascular Surgery, National University Health System, Singapore, Singapore.,Department of Cardiothoracic and Vascular Surgery, National University Heart Centre, Singapore, Singapore
| | - Hari Kumar Sampath
- Department of Cardiothoracic and Vascular Surgery, National University Health System, Singapore, Singapore.,Department of Cardiothoracic and Vascular Surgery, National University Heart Centre, Singapore, Singapore
| | - Sophia Bee Leng Ang
- Department of Anaesthesia, National University Health System, Singapore, Singapore
| | - Suresh Paranjothy
- Department of Anaesthesia, National University Health System, Singapore, Singapore
| | - John Kit Chung Tam
- Department of Cardiothoracic and Vascular Surgery, National University Health System, Singapore, Singapore.,Department of Cardiothoracic and Vascular Surgery, National University Heart Centre, Singapore, Singapore
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Risse J, Schubert AK, Wiesmann T, Huelshoff A, Stay D, Zentgraf M, Kirschbaum A, Wulf H, Feldmann C, Meggiolaro KM. Videolaryngoscopy versus direct laryngoscopy for double-lumen endotracheal tube intubation in thoracic surgery - a randomised controlled clinical trial. BMC Anesthesiol 2020; 20:150. [PMID: 32546128 PMCID: PMC7296647 DOI: 10.1186/s12871-020-01067-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 06/08/2020] [Indexed: 02/07/2023] Open
Abstract
Background Double-lumen tube (DLT) intubation is necessary for thoracic surgery and other operations with the need for lung separation. However, DLT insertion is complex and might result in airway trauma. A new videolaryngoscopy (GVL) with a thin blade might improve the intubation time and reduce complexity as well as iatrogenic airway complications compared to conventional direct laryngoscopy (DL) for DLT intubation. Methods A randomised, controlled trial was conducted in 70 patients undergoing elective thoracic surgery using DLT for lung separation. Primary endpoint was time to successful intubation. The secondary endpoints of this study were number of intubation attempts, the assessment of difficulty, any complications during DLT intubation and the incidence of objective trauma of the oropharynx and supraglottic space and intubation-related subjective symptoms. Results 65 patients were included (DL group [n = 31], GVL group [n = 34]). Median intubation time (25th–75th percentiles) in GVL group was 93 s (63–160) versus 74 (58–94) in DL group [p = 0.044]. GVL resulted in significantly improved visualisation of the larynx (Cormack and Lehane grade of 1 in GVL group was 97% vs. 74% in DL Group [p = 0.008]). Endoscopic examinations revealed significant differences in GVL group compared to DL group showing less red-blooded vocal cord [p = 0.004], vocal cord haematoma [p = 0.022] and vocal cord haemorrhage [p = 0.002]. No significant differences regarding the postoperative subjective symptoms of airway were found. Conclusions Videolaryngoscopy using the GlideScope®-Titanium shortly prolongs DLT intubation duration compared to direct laryngoscopy but improves the view. Objective intubation trauma but not subjective complaints are reduced. Trial registration German Clinical Trial Register DRKS00020978, retrospectively registered on 09. March 2020.
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Affiliation(s)
- Joachim Risse
- Center of Emergency Medicine, University Hospital Essen, Hufelandstrasse 55, 45122, Essen, Germany. .,Department of Anesthesiology and Intensive Care Medicine, Philipps-University Marburg, Baldingerstraße, 35033, Marburg, Germany.
| | - Ann-Kristin Schubert
- Department of Anesthesiology and Intensive Care Medicine, Philipps-University Marburg, Baldingerstraße, 35033, Marburg, Germany
| | - Thomas Wiesmann
- Department of Anesthesiology and Intensive Care Medicine, Philipps-University Marburg, Baldingerstraße, 35033, Marburg, Germany
| | - Ansgar Huelshoff
- Department of Anesthesiology and Intensive Care Medicine, Philipps-University Marburg, Baldingerstraße, 35033, Marburg, Germany
| | - David Stay
- Department of Anesthesiology and Intensive Care Medicine, Philipps-University Marburg, Baldingerstraße, 35033, Marburg, Germany
| | - Michael Zentgraf
- Department of Anesthesiology and Intensive Care Medicine, Philipps-University Marburg, Baldingerstraße, 35033, Marburg, Germany
| | - Andreas Kirschbaum
- Visceral, Thoracic and Vascular Surgery Clinic, University Hospital Giessen and Marburg GmbH, Baldingerstraße, 35033, Marburg, Germany
| | - Hinnerk Wulf
- Department of Anesthesiology and Intensive Care Medicine, Philipps-University Marburg, Baldingerstraße, 35033, Marburg, Germany
| | - Carsten Feldmann
- Department of Anesthesiology and Intensive Care Medicine, Philipps-University Marburg, Baldingerstraße, 35033, Marburg, Germany
| | - Karl Matteo Meggiolaro
- Department of Anesthesiology and Intensive Care Medicine, Philipps-University Marburg, Baldingerstraße, 35033, Marburg, Germany
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Liu Z, Zhao L, Zhu Y, Bao L, Jia QQ, Yang XC, Liang SJ. The efficacy and adverse effects of the Uniblocker and left-side double-lumen tube for one-lung ventilation under the guidance of chest CT. Exp Ther Med 2020; 19:2751-2756. [PMID: 32256757 DOI: 10.3892/etm.2020.8492] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Accepted: 01/22/2020] [Indexed: 11/06/2022] Open
Abstract
One-lung ventilation (OLV) is essential in numerous clinical procedures, in which the left-sided double-lumen tube (LDLT) is the most commonly used device. The application of bronchial blockers, including the Uniblocker or Arndt blocker, has increased in OLV. The present study aimed to compare the efficacy and adverse effects of the Uniblocker and LDLT for OLV under the guidance of chest CT. A total of 60 adult patients undergoing elective left-side thoracic surgery requiring OLV were included in the study. The patients were randomly assigned to the Uniblocker group (U group, n=30) or the LDLT group (D group, n=30). The time for initial tube placement, the number of optimal positions of the tube upon blind insertion, the number of attempts to adjust the tube to the optimal position, incidence of airway device displacement, injury to the bronchi and carina, the duration until lung collapse and the occurrence of sore throat and hoarseness over 24 h following surgery were recorded. The time for successful placement of the LDLT was 83.9±19.4 sec and that for the Uniblocker was 84.3±17.1 sec (P>0.05). The degree of lung collapse 1 min following opening of the pleura was greater in the D group than that in the U group (P<0.01) and the time required for the lung to completely collapse was shorter in the D group (3.3±0.5 min) than that in the U group (8.4±1.2 min; P<0.01). On the contrary, the incidence of injury to the bronchi and carina was lower in the U group (2/30 cases) than in the D group (10/30 cases; P=0.02); the incidence of sore throat was also lower in the U group (2/30 cases) compared with that in the D group (9/30 cases). The mean arterial pressure of patients immediately following intubation was lower in the U group (122.0±13.4 mmHg) than that in the D group (129.2±12.1 mmHg; P<0.05). The results of the present study indicated that the extraluminal use of the Uniblocker under guidance of chest CT is an efficient method with few adverse effects in left-side thoracic surgery. The study was registered at ClinicalTrials.gov on 16th December 2017 (no. NCT03392922).
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Affiliation(s)
- Zhuo Liu
- Department of Anesthesiology, The First Hospital of Qinhuangdao, Qinhuangdao, Hebei 066000, P.R. China
| | - Li Zhao
- Department of Thoracic Surgery, The First Hospital of Qinhuangdao, Qinhuangdao, Hebei 066000, P.R. China
| | - Yan Zhu
- Department of Anesthesiology, The First Hospital of Qinhuangdao, Qinhuangdao, Hebei 066000, P.R. China
| | - Lina Bao
- Department of Anesthesiology, The First Hospital of Qinhuangdao, Qinhuangdao, Hebei 066000, P.R. China
| | - Qian-Qian Jia
- Department of Anesthesiology, The First Hospital of Qinhuangdao, Qinhuangdao, Hebei 066000, P.R. China
| | - Xiao-Chun Yang
- Department of Anesthesiology, The First Hospital of Qinhuangdao, Qinhuangdao, Hebei 066000, P.R. China
| | - Shu-Juan Liang
- Department of Anesthesiology, The First Hospital of Qinhuangdao, Qinhuangdao, Hebei 066000, P.R. China
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10
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Shafy SZ, Hakim M, Kamata M, Tumin D, Krishna SG, Naguib A, Tobias JD. Intracuff pressure during one-lung ventilation in infants and children. J Pediatr Surg 2019; 54:1929-1932. [PMID: 30660384 DOI: 10.1016/j.jpedsurg.2018.10.110] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 10/08/2018] [Accepted: 10/31/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We prospectively evaluated intracuff pressure (IP) during one-lung ventilation (OLV) to characterize potential risk associated with overinflation of the cuff used for OLV. DESIGN Prospective observational study over a 2-year period, in infants and children undergoing thoracic surgery. The IPs of the tracheal and bronchial balloon were measured using a manometer and compared to a previously recommended threshold of 30 cmH2O. Data were compared by the device type used to achieve OLV. SETTING Freestanding tertiary-care pediatric hospital. PARTICIPANTS Patients ≤18 years of age undergoing thoracic procedures requiring OLV. INTERVENTIONS Measurement of IP. MEASUREMENTS AND MAIN RESULTS Thirty patients were enrolled (age 5 months-18 years) with a median weight of 28 kg. Median tracheal and bronchial IPs were 32 cmH2O (range: 11, 90) and 44 cmH2O (range: 10, 100), respectively. The tracheal and bronchial IPs exceeded 30 cmH2O in 13 of 20 patients (65%) and 21 of 30 patients (70%), respectively. CONCLUSIONS IP was high and in excess of recommended levels in most children undergoing OLV. Continuous monitoring of IP may be indicated during OLV to address the risks involved and ensure the prevention of complications related to high IP. TYPE OF STUDY Prospective comparative study. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Shabana Z Shafy
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH.
| | - Mohammed Hakim
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH
| | - Mineto Kamata
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH
| | - Dmitry Tumin
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH; Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH
| | - Senthil G Krishna
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH; Department of Anesthesiology & Pain Medicine, The Ohio State University College of Medicine, Columbus, OH
| | - Aymen Naguib
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH; Department of Anesthesiology & Pain Medicine, The Ohio State University College of Medicine, Columbus, OH
| | - Joseph D Tobias
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH; Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH; Department of Anesthesiology & Pain Medicine, The Ohio State University College of Medicine, Columbus, OH
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11
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Collins SR, Titus BJ, Campos JH, Blank RS. Lung Isolation in the Patient With a Difficult Airway. Anesth Analg 2019; 126:1968-1978. [PMID: 29189274 DOI: 10.1213/ane.0000000000002637] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
One-lung ventilation is routinely used to facilitate exposure for thoracic surgical procedures and can be achieved via several lung isolation techniques. The optimal method for lung isolation depends on a number of factors that include (1) the indication for lung isolation, (2) anatomic features of the upper and lower airway, (3) availability of equipment and devices, and (4) the anesthesiologist's proficiency and preferences. Though double-lumen endobronchial tubes (DLTs) are most commonly utilized to achieve lung isolation, the use of endobronchial blockers offer advantages in patients with challenging airway anatomy. Anesthesiologists should be familiar with existing alternatives to the DLT for lung isolation and alternative techniques for DLT placement in the patient with a difficult airway. Newer technologies such as videolaryngoscopy with or without adjunctive fiberoptic bronchoscopy may facilitate intubation and lung isolation in difficult airway management.
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Affiliation(s)
- Stephen R Collins
- From the Department of Anesthesiology, University of Virginia Health System, Charlottesville, Virginia
| | - Brian J Titus
- From the Department of Anesthesiology, University of Virginia Health System, Charlottesville, Virginia
| | - Javier H Campos
- Department of Anesthesia, University of Iowa Healthcare, Iowa City, Iowa
| | - Randal S Blank
- From the Department of Anesthesiology, University of Virginia Health System, Charlottesville, Virginia
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12
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13
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Anesthesia for Lung Resection. Anesthesiology 2018. [DOI: 10.1007/978-3-319-74766-8_10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Wang HY, Ting CK, Liou JY, Chen KH, Tsou MY, Chang WK. A previously published propofol-remifentanil response surface model does not predict patient response well in video-assisted thoracic surgery. Medicine (Baltimore) 2017; 96:e6895. [PMID: 28489797 PMCID: PMC5428631 DOI: 10.1097/md.0000000000006895] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Modern anesthesia usually employs a hypnotic and an analgesic to produce synergistic sedation and analgesia. Two remifentanil-propofol interaction response surface models were used to predict sedation using Observer's Assessment of Alertness/Sedation (OAA/S) scores; one predicts an OAA/S <2 and the other <4. We hypothesized that both models would predict regained responsiveness (RR) after video-assisted thoracic surgery (VATS) to reduce total anesthesia time and make early extubation clinically relevant. We included 30 patients undergoing VATS received total intravenous anesthesia (TIVA) combined with thoracic epidural anesthesia (TEA). Pharmacokinetic profiles were calculated using Tivatrainer. Model predictions were compared with observations to evaluate the accuracy and precision of emergence model predictions. The mean (standard deviation) differences between when a patient responded to their name and the time when the model predicted a 50% probability of patient response were 30.80 ± 17.77 and 13.71 ± 11.35 minutes for the OAA/S <2 model and <4 model, respectively. Both models had a limited ability to predict patient response in our patients. Both models identified target concentration pairs predicting time of RR in volunteers and some elective surgeries, but another model of epidural and intravenous anesthetic combinations may be needed to predict time of RR after VATS under TIVA with TEA.
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Affiliation(s)
- Hsin-Yi Wang
- Department of Anesthesiology, Taipei Veterans General Hospital and National Yang-Ming University, Taipei
- Institute of Translational and Interdisciplinary Medicine and Department of Biomedical Sciences and Engineering, National Central University, Chungli
| | - Chien-Kun Ting
- Department of Anesthesiology, Taipei Veterans General Hospital and National Yang-Ming University, Taipei
| | - Jing-Yang Liou
- Department of Anesthesiology, Taipei Veterans General Hospital and National Yang-Ming University, Taipei
| | - Kun-Hui Chen
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital and National Yang-Ming University
| | - Mei-Young Tsou
- Department of Anesthesiology, Taipei Veterans General Hospital and National Yang-Ming University, Taipei
| | - Wen-Kuei Chang
- Department of Anesthesiology, Taipei Veterans General Hospital and National Yang-Ming University, Taipei
- Department of Anesthesiology, Taipei Veterans General Hospital and Taipei Municipal Gan-Dau Hospital, Taipei, Taiwan
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15
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Intubation with VivaSight or conventional left-sided double-lumen tubes: a randomized trial. Can J Anaesth 2015; 62:762-9. [DOI: 10.1007/s12630-015-0329-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 01/19/2015] [Indexed: 10/24/2022] Open
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16
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Neustein SM. Pro: Bronchial Blockers Should Be Used Routinely for Providing One-Lung Ventilation. J Cardiothorac Vasc Anesth 2015; 29:234-6. [DOI: 10.1053/j.jvca.2014.07.028] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2014] [Indexed: 11/11/2022]
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17
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Lee DK, Kim HK, Lee K, Choi YH, Lim SH, Kim H. Optimal Respiratory Rate for Low-Tidal Volume and Two-Lung Ventilation in Thoracoscopic Bleb Resection. J Cardiothorac Vasc Anesth 2014; 29:972-6. [PMID: 25440636 DOI: 10.1053/j.jvca.2014.06.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Indexed: 11/11/2022]
Abstract
OBJECTIVES One-lung ventilation is considered to be mandatory in video-assisted thoracoscopic surgery. However, the authors showed in a previous report that two-lung ventilation with low tidal volume is feasible in thoracoscopic bleb resection (TBR). In this study, they evaluated optimal respiratory rate during TBR under two-lung ventilation with low-tidal volume anesthesia. DESIGN A prospective, randomized, single-blinded intervention study. SETTING An operating room in a teaching hospital. PARTICIPANTS Forty-eight patients who underwent scheduled TBR under general anesthesia. INTERVENTIONS TBR was performed under low-tidal-volume (5 mL/kg), two-lung ventilation. Respiratory rate (RR) varied according to the protocol: 15 (group I), 18 (group II), and 22 cycles/min (group III). Using block randomization method, 16 patients were assigned to each of 3 groups. MEASUREMENTS AND MAIN RESULTS Minute ventilation of group I was lowered significantly compared with the other groups (p<0.001). The results of arterial blood gas analysis were in the physiologic range in all patients. Surgery and anesthetic times and number of endostaples used were not significantly different among the 3 groups. CONCLUSIONS The RR of 15 cycles/min with low-tidal volume (5 mL/kg) and two-lung ventilation did not produce abnormal physiologic changes including arterial pH, partial arterial oxygen pressure, and partial pressure of carbon dioxide and guaranteed an optimal surgical field. Therefore, these setting are considered acceptable for two-lung ventilation during TBR.
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Affiliation(s)
- Dong Kyu Lee
- Departments of *Anesthesiolafogy and Pain Medicine
| | - Hyun Koo Kim
- Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Kanghoon Lee
- Department of Thoracic and Cardiovascular Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Young Ho Choi
- Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Sang Ho Lim
- Departments of *Anesthesiolafogy and Pain Medicine
| | - Heezoo Kim
- Departments of *Anesthesiolafogy and Pain Medicine.
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18
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Bilbao Ares A, Romero Menchaca O, Ramírez Gil E, Castañeda Pascual M, Guelbenzu Zazpe J, Salvador Bravo M. [Rupture of left main bronchus due to a left double-lumen tube in patient with a history of radiotherapy]. ACTA ACUST UNITED AC 2014; 62:218-21. [PMID: 25015698 DOI: 10.1016/j.redar.2014.05.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Revised: 05/19/2014] [Accepted: 05/20/2014] [Indexed: 11/28/2022]
Abstract
Airway injury caused by double-lumen tubes is a rare but potentially serious complication. We describe the case of a patient who had a bronchial rupture during one-lung ventilation with left double-lumen tube, complicated with a secondary cardiac arrest. She had a full recovery without sequelae. Underlying causes of the patient were a history of radiotherapy, and a possible overinflation of bronchial cuff, that it could contribute to the development of this complication. The possible airway injury should be considered by all practitioners who employ double-lumen tubes for the care of their patients.
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Affiliation(s)
- A Bilbao Ares
- Servicio de Anestesia y Reanimación, Complejo Hospitalario de Navarra, Pamplona, Navarra, España.
| | - O Romero Menchaca
- Servicio de Anestesia y Reanimación, Complejo Hospitalario de Navarra, Pamplona, Navarra, España
| | - E Ramírez Gil
- Servicio de Cirugía Torácica, Complejo Hospitalario de Navarra, Pamplona, Navarra, España
| | - M Castañeda Pascual
- Servicio de Anestesia y Reanimación, Complejo Hospitalario de Navarra, Pamplona, Navarra, España
| | - J Guelbenzu Zazpe
- Servicio de Cirugía Torácica, Complejo Hospitalario de Navarra, Pamplona, Navarra, España
| | - M Salvador Bravo
- Servicio de Anestesia y Reanimación, Complejo Hospitalario de Navarra, Pamplona, Navarra, España
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19
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Kim HY, Baek SH, Kim KH, Kim NW. Endobronchial hemorrhage after intubation with double-lumen endotracheal tube in a patient with idiopathic thrombocytopenic purpura for minimally invasive cardiac surgery: a case report. Korean J Anesthesiol 2014; 66:59-63. [PMID: 24567815 PMCID: PMC3927003 DOI: 10.4097/kjae.2014.66.1.59] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Revised: 01/14/2013] [Accepted: 01/14/2013] [Indexed: 11/10/2022] Open
Abstract
Minimally invasive cardiac surgery (MICS) requires lung isolation. Lung isolation is usually achieved with double-lumen endotracheal tube (DLT). Patients with idiopathic thrombocytopenic purpura (ITP) have an increased risk of bleeding events. We suspected endobronchial hemorrhage after exchange of DLT during induction of anesthesia for replacement of mitral valve in a 62-year-old man with a known ITP. The MICS was stopped and bronchial artery embolization was performed in the angiographic room. In the present case, in order to reduce the risk of bronchial arterial injury in ITP patient we intubated with single lumen endotracheal tube. Lung isolation led to achievement of intermittent total lung deflation. Based on the results, we recommend a high-dose intravenous immunoglobulin therapy and platelet transfusion prior to cardiac surgery in patients with ITP to increase platelet count. Moreover, it is proposed that in order to clear the vision during the operation, ventilation can be held or made intermittent both prior to cardiopulmonary bypass or at its conclusion to permit exposure.
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Affiliation(s)
- Hee Young Kim
- Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Busan, Korea
| | - Seung Hoon Baek
- Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Busan, Korea
| | - Kyoung Hoon Kim
- Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Busan, Korea
| | - Nam Won Kim
- Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Busan, Korea
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20
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Arthur ME, Odo N, Parker W, Weinberger PM, Patel VS. CASE 9--2014: Supracarinal tracheal tear after atraumatic endotracheal intubation: anesthetic considerations for surgical repair. J Cardiothorac Vasc Anesth 2014; 28:1137-45. [PMID: 24439170 DOI: 10.1053/j.jvca.2013.08.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2013] [Indexed: 12/27/2022]
Affiliation(s)
- Mary E Arthur
- Departments of Anesthesiology and Perioperative Medicine.
| | - Nadine Odo
- Departments of Anesthesiology and Perioperative Medicine
| | | | | | - Vijay S Patel
- Surgery, Medical College of Georgia, Georgia Regents University, Augusta, GA
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21
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Iatrogenic Left Main Bronchus Injury following Atraumatic Double Lumen Endotracheal Tube Placement. Case Rep Anesthesiol 2013; 2013:524348. [PMID: 24288629 PMCID: PMC3833405 DOI: 10.1155/2013/524348] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Accepted: 09/27/2013] [Indexed: 11/18/2022] Open
Abstract
Tracheobronchial disruption is an uncommon but severe complication of double lumen endotracheal tube placement. The physical properties of a double lumen tube (large external diameter and length) make tracheobronchial injury more common than that associated with smaller single lumen endotracheal tubes. Here we present the case of an iatrogenic left main bronchus injury caused by placement of a double lumen tube in an otherwise unremarkable airway.
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22
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Seong YW, Kang CH, Kim JT, Moon HJ, Park IK, Kim YT. Video-Assisted Thoracoscopic Lobectomy in Children: Safety, Efficacy, and Risk Factors for Conversion to Thoracotomy. Ann Thorac Surg 2013; 95:1236-42. [DOI: 10.1016/j.athoracsur.2013.01.013] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2012] [Revised: 01/10/2013] [Accepted: 01/11/2013] [Indexed: 11/28/2022]
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Abstract
Although disposable double-lumen tubes have been used for many years, there is still controversy regarding what size and which side to use for thoracic procedures requiring lung isolation. Thoracic and nonthoracic anesthesiologists often debate performance, efficiency, and outcome of small and large double-lumen tubes, and left- and right-sided tubes. This article focuses on current data in the literature and expert opinion on the topic.
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Affiliation(s)
- Alessia Pedoto
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
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24
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Ceylan KC, Kaya SO, Samancilar O, Usluer O, Gursoy S, Ucvet A. Intraoperative management of tracheobronchial rupture after double-lumen tube intubation. Surg Today 2012; 43:757-62. [DOI: 10.1007/s00595-012-0315-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Accepted: 05/17/2012] [Indexed: 12/29/2022]
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Toolabi K, Aminian A, Javid MJ, Mirsharifi R, Rabani A. Minimal access mediastinal surgery: One or two lung ventilation? J Minim Access Surg 2011; 5:103-7. [PMID: 20407569 PMCID: PMC2843124 DOI: 10.4103/0972-9941.59308] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2009] [Accepted: 11/04/2009] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND: Minimal access mediastinal surgery (MAMS) is usually performed under general anaesthesia with double lumen tubes (DLT). The aim of this study is to evaluate two lung ventilation through single lumen tubes (SLT) during thoracoscopic sympathectomy for hyperhidrosis and thoracoscopic thymectomy for myasthenia gravis. METHODS: In this prospective non-randomized study, MAMS was performed in 58 patients with hyperhidrosis and 42 patients with myasthenia gravis, from January 2002 to December 2008. Patients were intubated with a DLT or SLT, 50 patients in each group. In the DLT group, endobronchial tubes were placed using the traditional blind approach and one lung ventilation was confirmed clinically. In the SLT group, the hemithorax was insufflated with CO2 in conjunction with two-lung anaesthesia. All the patients were evaluated for haemodynamic stability, oxygen saturation of haemoglobin (Spo2), end-tidal Pco2 (ETPco2), times required for intubation and surgery, satisfaction of surgeon with regard to exposure and postoperative complications. RESULTS: In the SLT group, all the patients had stable haemodynamic and ventilation parameters. In the DLT group, haemodynamic instability occurred in two, decrease in Spo2 in four and increase in ETPco2 in three patients. One patient in the DLT group developed vocal cord granuloma two months later. Time required for surgery and the surgeon's opinion with regard to exposure were similar for both groups. CONCLUSION: Thoracoscopic surgery when used in cases where a well-collapsed lung may not be essential, since surgery is not performed on the lung itself, does not require DLT. SLT is safe in MAMS. It provides good surgical exposure and decreases the cost, time and undesirable complications of DLT.
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Affiliation(s)
- Karamollah Toolabi
- Department of Surgery, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
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26
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Ruetzler K, Grubhofer G, Schmid W, Papp D, Nabecker S, Hutschala D, Lang G, Hager H. Randomized clinical trial comparing double-lumen tube and EZ-Blocker ® for single-lung ventilation. Br J Anaesth 2011; 106:896-902. [DOI: 10.1093/bja/aer086] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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27
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Venkataramanappa V, Boujoukos AJ, Sakai T. The diagnostic challenge of a tracheal tear with a double-lumen endobronchial tube: massive air leak developing from the mouth during mechanical ventilation. J Clin Anesth 2011; 23:66-70. [PMID: 21296251 DOI: 10.1016/j.jclinane.2009.10.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2009] [Revised: 10/13/2009] [Accepted: 10/16/2009] [Indexed: 10/18/2022]
Abstract
The case of a 78 year-old woman who underwent a right lower lobectomy using a 35-French, left-sided, double-lumen endobronchial tube (DLET) is presented. Multiple adjustments were needed for the DLET's proper placement. At the end of surgery, sudden loss of tidal volume with a large air leak from the patient's mouth was noted. Fiberoptic bronchoscopic examination through the DLET was negative. Rupture of the tracheal cuff was suspected, and the DLET was replaced with a single-lumen tube. In the intensive care unit, the massive air leak from the mouth recurred during mechanical ventilation. Nasal fiberoptic bronchoscopic examination showed a longitudinal laceration of the membranous portion of the trachea extending from the subglottic area to the orifice of the right bronchus. Surgical repair of the tear was performed.
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Affiliation(s)
- Vani Venkataramanappa
- Department of Anesthesiology, University of Pittsburgh Medical Center, UPMC Montefiore, Pittsburgh, PA 15213, USA
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28
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Kim J, Lim T, Bahk JH. Tracheal laceration during intubation of a double-lumen tube and intraoperative fiberoptic bronchoscopic evaluation through an LMA in the lateral position -A case report-. Korean J Anesthesiol 2011; 60:285-9. [PMID: 21602980 PMCID: PMC3092965 DOI: 10.4097/kjae.2011.60.4.285] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2010] [Revised: 10/06/2010] [Accepted: 10/08/2010] [Indexed: 11/10/2022] Open
Abstract
A 76-year-old, 148-cm woman was scheduled for right upper lobectomy. A 32 Fr left-sided double lumen tube was placed using a conventional technique. Despite several attempts under fiberoptic bronchoscope-guidance, we could not locate the double lumen tube properly. We thus decided to proceed with the bronchial tube in the right mainstem bronchus. During surgery, 8-cm-long laceration was noted on the posterolateral side of the trachea. To check the possibility of laceration of the proximal trachea, the double lumen tube was changed to an LMA for use as a conduit for fiberoptic bronchoscopic evaluation in the lateral position. A plain endotracheal tube with the cuff modified and collapsed was re-intubated after evaluation. And then she was transferred to SICU.
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Affiliation(s)
- Joohee Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
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Gologorsky E, Gologorsky A, Stahl K, Nguyen DM, Pham SM. Tension pneumoperitoneum as the sole presentation of an intraoperative bronchial rupture. J Heart Lung Transplant 2010; 29:1078-9. [DOI: 10.1016/j.healun.2010.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2010] [Revised: 04/15/2010] [Accepted: 04/28/2010] [Indexed: 10/19/2022] Open
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30
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Neustein SM. The Use of Bronchial Blockers for Providing One-Lung Ventilation. J Cardiothorac Vasc Anesth 2009; 23:860-8. [PMID: 19632864 DOI: 10.1053/j.jvca.2009.05.014] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2009] [Indexed: 11/11/2022]
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Ho AMH, Ng SK, Tsang KHS, Au SW, Ng CSH, Critchle LAH, Karmakar MK. A Technique that may Improve the Reliability of Endobronchial Blocker Positioning during Adult One-lung Anaesthesia. Anaesth Intensive Care 2009; 37:1012-6. [DOI: 10.1177/0310057x0903700614] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
We describe a novel technique, previously applied to small children, for adult one-lung anaesthesia in which a single-lumen endotracheal tube is used with an endobronchial balloon blocker. The main aims of the technique are to reduce the likelihood of cephalad displacement of the balloon into the trachea and to facilitate directional placement of the endobronchial balloon. We present five illustrative cases of one-lung anaesthesia in patients of adult size, in which the endotracheal tube-endobronchial balloon technique was considered preferable to the use of a double-lumen tube technique. The situations included difficult intubation, need for postoperative ventilation, a tortuous trachea and an unexpected need to perform one-lung anaesthesia. The technique involved deliberate placement of the endotracheal tube tip near the carina to block cephalad dislodgement of the blocker. The chance of the balloon blocking the endotracheal tube tip could be further reduced by having the intraluminal endobronchial balloon blocker emerge through the Murphy eye.
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Affiliation(s)
- A. M. H. Ho
- Departments of Anaesthesia and Intensive Care and Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR
- Professor, Department of Anaesthesia and Intensive Care
| | - S. K. Ng
- Departments of Anaesthesia and Intensive Care and Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR
- Consultant, Department of Anaesthesia and Intensive Care
| | - K. H. S. Tsang
- Departments of Anaesthesia and Intensive Care and Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR
- Associate Consultant, Department of Anaesthesia and Intensive Care
| | - S. W. Au
- Departments of Anaesthesia and Intensive Care and Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR
- Medical Officer, Department of Anaesthesia and Intensive Care
| | - C. S. H. Ng
- Departments of Anaesthesia and Intensive Care and Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR
- Resident Specialist, Department of Surgery
| | - L. A. H. Critchle
- Departments of Anaesthesia and Intensive Care and Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR
- Professor, Department of Anaesthesia and Intensive Care
| | - M. K. Karmakar
- Departments of Anaesthesia and Intensive Care and Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR
- Associate Professor, Department of Anaesthesia and Intensive Care
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Lin YT, Zuo Z, Lo PH, Hseu SS, Chang WK, Chan KH, Yuan HB. Bilateral tension pneumothorax and tension pneumoperitoneum secondary to tracheal tear in a patient with relapsing polychondritis. J Chin Med Assoc 2009; 72:488-91. [PMID: 19762318 DOI: 10.1016/s1726-4901(09)70413-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Relapsing polychondritis (RP) is a rare disease that is characterized by recurrent inflammation and destruction of cartilage and connective tissues. RP can have significant airway pathology that may require procedures to maintain airway patency and thus may have serious implications for anesthesiologists. Anesthesiologists must be prepared to deal with the possible complications that may occur during airway manipulation in patients with RP. Here, we present a case of life-threatening bilateral tension pneumothorax and tension pneumoperitoneum that developed after a tracheal tear during Montgomery T-tube insertion in a patient with tracheal stenosis due to RP. Correct diagnosis was delayed due to a misdiagnosis of airway obstruction. As a result, we emphasize that bilateral tension pneumothorax should be considered during refractory cardiac arrest in patients with increased airway pressure. A high index of suspicion and adequate management are mandatory for patients to survive these life-threatening complications.
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Affiliation(s)
- Yu-Ting Lin
- Department of Anesthesiology, Taipei Veterans General Hospital and National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
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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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Cohen E. Pro: The New Bronchial Blockers Are Preferable to Double-Lumen Tubes for Lung Isolation. J Cardiothorac Vasc Anesth 2008; 22:920-4. [PMID: 19038740 DOI: 10.1053/j.jvca.2008.09.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2008] [Indexed: 02/08/2023]
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Yuan SM, Shinfeld A, Raanani E. Cardiopulmonary bypass as an adjunct for the noncardiac surgeon. J Cardiovasc Med (Hagerstown) 2008; 9:338-55. [PMID: 18334888 DOI: 10.2459/jcm.0b013e3282eee889] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The use of cardiopulmonary bypass (CPB) in noncardiac surgical settings has been increasingly developed and has greatly benefited noncardiac surgeon. A few years after the advent of CPB as well as profound hypothermic circulatory arrest in the early years, it was employed by neurosurgeons in cerebrovascular surgery and by general thoracic surgeons in carinal tumor resection. Indications for CPB were extended and modified year after year. It has facilitated not only the surgical management by surgeons of lesions that cannot be managed safely and effectively by conventional techniques, or conventional techniques carry significant risks to the patient, but also the preservation of the viability of multiple organ procurement, the practice of isolated limb perfusion for the treatment of malignancies of the extremities, and emergent cardiopulmonary resuscitation. Owing to the complications arising from CPB and profound hypothermic circulatory arrest, such as postoperative bleeding, coagulopathy, and neurologic deficits, efforts have been made to avoid these common hazards. Thus, innovative techniques including extracorporeal membrane oxygenation, percutaneous cardiopulmonary support, venovenous bypass, normothermic CPB, and minimally invasive approaches have emerged and played an important role as alternatives of standard CPB in decreasing morbidity and mortality and improving survival.
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Affiliation(s)
- Shi-Min Yuan
- Department of Cardiac and Thoracic Surgery, The Chaim Sheba Medical Center, Tel Hashomer, Israel
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Belyamani L, Kabiri H, Kamili ND. Rupture de la membraneuse trachéale après intubation par une sonde double lumière droite. Can J Anaesth 2008; 55:192-4. [DOI: 10.1007/bf03016100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Thomas V, Neustein SM. Tracheal Laceration After the Use of an Airway Exchange Catheter for Double-Lumen Tube Placement. J Cardiothorac Vasc Anesth 2007; 21:718-9. [PMID: 17905282 DOI: 10.1053/j.jvca.2006.08.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2006] [Indexed: 11/11/2022]
Affiliation(s)
- Vinoo Thomas
- Department of Anesthesiology, The Mount Sinai Hospital, New York, NY 10029-6574, USA
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Campos JH. Which device should be considered the best for lung isolation: double-lumen endotracheal tube versus bronchial blockers. Curr Opin Anaesthesiol 2007; 20:27-31. [PMID: 17211163 DOI: 10.1097/aco.0b013e3280111e2a] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW This review is a clinical comparison between double-lumen endotracheal tubes and bronchial blockers to determine which device is considered the best for lung isolation. RECENT FINDINGS Double-lumen endotracheal tubes and bronchial blockers have been found to be clinically equivalent in terms of performance in providing lung collapse for patients with normal airways. In the last five years, however, numerous reports have indicated a preference for the use of bronchial blockers in patients with airway abnormalities. For nonthoracic anesthesiologists who have limited experience in thoracic anesthesia cases, none of the devices (double-lumen tubes or bronchial blockers) have been shown to provide any advantage while in use due to a high incidence of unrecognized malpositions. Overall, each device provides advantages depending upon the case, such as absolute lung separation with a double-lumen endotracheal tube or the use of a bronchial blocker in a difficult airway for a patient requiring lung isolation. SUMMARY Double-lumen endotracheal tubes and bronchial blockers should be part of the armamentarium of every anesthesiologist involved in lung isolation techniques and every device should be tailored to specific case needs.
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Affiliation(s)
- Javier H Campos
- University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, Iowa 52242, USA.
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Guerra MS, Miranda JA, Caiado A, Almeida J, Moura e Sá J, Leal F, Vouga L. [Iatrogenic tracheal rupture: a case report and indications for conservative management]. REVISTA PORTUGUESA DE PNEUMOLOGIA 2006; 12:71-8. [PMID: 16669134 DOI: 10.1016/s0873-2159(15)30421-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Tracheal rupture after endotracheal intubation requires immediate intervention. There have been an increasing number of reports that describe nonsurgical management of this issue. We report the case of a 47-year-old woman who experienced an iatrogenic tracheal rupture during endotracheal intubation for a surgical procedure with general anaesthesia. She was successfully managed conservatively with a broad-spectrum antibiotic. We managed it non-operatively, because the patient had a small tear, was hemodynamically stable, show no evidence of infection or respiratory failure, and the diagnosis was not immediate. Bronchoscopy was a good diagnostic tool and it was used to make decisions regarding conservative management, and to detect granulation tissue and rule out any tracheal stenosis after treatment. We review available literature on conservative management of tracheal rupture. Immediate recognition and adequate treatment are very important in managing this potentially fatal situation. The final decision should be based on clinical, radiologic and bronchoscopic findings.
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Affiliation(s)
- Miguel S Guerra
- Serviço de Cirurgia Cardiotorácica, Centro Hospitalar de Vila Nova de Gaia, Portugal.
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Affiliation(s)
- Govind R Rajan
- Veterans Affairs Medical Center, Department of Anesthesiology, Saint Louis University, St. Louis, MO, ,
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