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Li J, Qian Y, Lei Y, Huo W, Xu M, Zhang Y, Ji Q, Yang J, Liu H, Hou Y. Combination of computed tomography measurements and flexible video bronchoscope guidance for accurate placement of the right-sided double-lumen tube: a randomised controlled trial. BMJ Open 2023; 13:e066541. [PMID: 38011975 PMCID: PMC10685955 DOI: 10.1136/bmjopen-2022-066541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 11/07/2023] [Indexed: 11/29/2023] Open
Abstract
OBJECTIVE To compare the modified strategy for the right-sided double-lumen tube (R-DLT) placement using a combination of CT measurements and flexible video bronchoscopy guidance with traditional bronchoscopy technique. TRIAL DESIGN, SETTING AND PARTICIPANTS Double-blind, parallel randomised control trial at a tertiary care medical centre in China. 100 patients undergoing video-assisted thoracoscopic surgery and requiring R-DLT were randomly allocated to the control group and the intervention group. INTERVENTION The control group used the traditional bronchoscopy-guided technique. In the intervention group, the length and anteroposterior diameter of the right main bronchus (RMB) were measured on CT images to select the side and size of the Rüsch tube, and then a black depth marker was placed on the tube according to the difference between the length of the RMB and the bronchial cuff. Under the guidance of bronchoscopy, the depth marker should be placed parallel to the tracheal carina and a characteristic white line on the tube should be parallel to the midline of the tracheal carina. MAIN OUTCOMES The primary endpoint was the positioning of right upper lobe (RUL) ventilatory slot and RUL bronchial orifice. The secondary endpoints included intubation data and perioperative adverse events. RESULTS Compared with the control group, our modified strategy significantly increased the optimal and acceptable position rate (76% vs 98%, respectively; p<0.039), decreased the replacement rate (80% vs 94%; p=0.042), shortened the intubation time (101.4±7.3 s vs 75.2±8.1 s; p=0.019) and reduced the incidence of transient hypoxaemia (25% vs 6%; p=0.022), subglottic resistance (20% vs 6%; p=0.037), tracheobronchial injury (35% vs 13%; p=0.037) and postoperative RUL collapse (15% vs 2%; p=0.059). CONCLUSION This study demonstrates the superiority of our strategy and provides a new viable method for R-DLT placement. TRIAL REGISTRATION NUMBER Chinese Clinical Trial Registry (ChiCTR1900021676).
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Affiliation(s)
- Jian Li
- Departments of Anaesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
- Departments of Anaesthesiology, Dushu Lake Hospital Affiliated to Soochow University, Suzhou, Jiangsu Province, China
| | - Yingcong Qian
- Departments of Anaesthesiology, Dushu Lake Hospital Affiliated to Soochow University, Suzhou, Jiangsu Province, China
| | - Yishan Lei
- Departments of Anaesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Wenwen Huo
- Departments of Anaesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Mingzhu Xu
- Departments of Anaesthesiology, Dushu Lake Hospital Affiliated to Soochow University, Suzhou, Jiangsu Province, China
| | - Yuanyuan Zhang
- Departments of Anaesthesiology, Dushu Lake Hospital Affiliated to Soochow University, Suzhou, Jiangsu Province, China
| | - Qiuyuan Ji
- Departments of Anaesthesiology, Dushu Lake Hospital Affiliated to Soochow University, Suzhou, Jiangsu Province, China
| | - Jianping Yang
- Departments of Anaesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
- Departments of Anaesthesiology, Dushu Lake Hospital Affiliated to Soochow University, Suzhou, Jiangsu Province, China
| | - Huayue Liu
- Departments of Anaesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Yongheng Hou
- Departments of Anaesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
- Departments of Anaesthesiology, Dushu Lake Hospital Affiliated to Soochow University, Suzhou, Jiangsu Province, China
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Khidr AM, El Tahan MR. Difficult lung separation. An insight into the challenges faced during COVID-19 pandemic. Saudi J Anaesth 2021; 15:300-311. [PMID: 34764837 PMCID: PMC8579506 DOI: 10.4103/sja.sja_1086_20] [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: 11/04/2020] [Accepted: 11/05/2020] [Indexed: 11/29/2022] Open
Abstract
Difficult lung isolation or separation in patients undergoing thoracic surgery using one-lung ventilation might be attributed to upper airway difficulty or abnormal anatomy of the lower airway. Additionally, adequate deflation of the surgical lung can impair surgical exposure. The coronavirus disease 2019 (COVID-19) has a harmful consequence for both patients and anesthesiologists. Management of patients with difficult lung isolation can be challenging during the COVID-19 pandemic. Careful planning and preparation, preoperative routine testing, protective personal equipment, standard safety measures, proper preoxygenation, and individualize the patients care are required for successful lung separation. A systematic approach for management of difficult lung separation is centered around securing the airway and providing adequate ventilation using either a blocker or double-lumen tube. Several measures are described to expedite lung collapse.
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Affiliation(s)
- Alaa M Khidr
- Department of Anesthesiology, King Fahd Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Al Khobar, Saudi Arabia
| | - Mohamed R El Tahan
- Department of Anesthesiology, King Fahd Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Al Khobar, Saudi Arabia
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Dependent Lung Pulmonary Artery Hypoplasia as a Cause of Hypoxia during One-lung Ventilation. Anesthesiology 2021; 134:770-771. [PMID: 33592100 DOI: 10.1097/aln.0000000000003720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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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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Khalifa C, Fossoul S, Momeni M, Lacroix V, Watremez C. An original backup technique to assess the correct positioning of right-sided double-lumen tubes without fiberoptic bronchoscopy: A pilot feasibility study. Ann Card Anaesth 2020; 23:75-79. [PMID: 31929252 PMCID: PMC7034193 DOI: 10.4103/aca.aca_127_18] [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] [Indexed: 12/04/2022] Open
Abstract
Background: Accurate positioning of a right-sided double-lumen tube is essential but challenging due to the location and the potential obstruction of the right upper lobe bronchus. Fiberoptic bronchoscopy is, therefore, necessary but requires a specific training period for the anesthesiologist and might not always be available. Objective: We describe an original backup technique to assess the correct placement of these tubes in cases a fiberopetic bronchoscopy is lacking. Design: Prospective pilot feasibility study with 10 adult patients scheduled for a left thoracic surgery. Setting: Operating theater in a universitary hospital. Materials and Methods: The new technique uses a fluoroscopy and an adult central venous catheter wire. The time needed to perform the new technique, its success rate and its efficacy in properly exclude the left lung were evaluated. Any oxygen desaturation episode (SpO2 <90%) was considered. The technique was performed by two anesthesiologists with different experience in thoracic anesthesia. Results: The success rate of our technique was 90%, which did not depend on the anesthesiologist's experience. The range of time to successfully place the tube in the dorsal decubitus position and subsequently in the right lateral decubitus position was respectively 1 min–6 min and 1 min–15 min. None of the patients presented any desaturation episodes. Conclusions: We describe an original, safe, and acceptable backup technique to properly insert right-sided double-lumen endobronchial tubes, whenever a fiberoptic bronchoscopy is not available. Moreover, this technique is easy enough to be performed by anesthesiologists with limited experience in thoracic anesthesia.
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Affiliation(s)
- Céline Khalifa
- Department of Anesthesiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Sophie Fossoul
- Department of Acute and Emergency Medicine, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Mona Momeni
- Department of Anesthesiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Valérie Lacroix
- Department of Cardiothoracic and Vascular Surgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Christine Watremez
- Department of Anesthesiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
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Langiano N, Fiorelli S, Deana C, Baroselli A, Bignami EG, Matellon C, Pompei L, Tornaghi A, Piccioni F, Orsetti R, Coccia C, Sacchi N, D'Andrea R, Brazzi L, Franco C, Accardo R, Di Fuccia A, Baldinelli F, De Negri P, Gratarola A, Angeletti C, Pugliese F, Micozzi MV, Massullo D, Della Rocca G. Airway management in anesthesia for thoracic surgery: a "real life" observational study. J Thorac Dis 2019; 11:3257-3269. [PMID: 31559028 DOI: 10.21037/jtd.2019.08.57] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background One-lung ventilation (OLV) in thoracic anesthesia is required to provide good surgical exposure. OLV is commonly achieved through a double lumen tube (DLT) or a bronchial blocker (BB). Malposition is a relevant issue related to these devices use. No prospective studies with adequately large sample size have been performed to evaluate the malposition rate of DLTs and BBs. Methods A total of 2,127 patients requiring OLV during thoracic surgery were enrolled. The aim of this multicenter prospective observational study performed across 26 academic and community hospitals is to evaluate intraoperative malposition rate of DLTs and BBs. We also aim to assess: which device is the most used to achieve OLV, the frequency of bronchoscope (BRO) use, the incidence rate of desaturation during OLV and the role of other factors that can correlate to this event, and incidence of difficult airway. Results Malposition rate for DLTs was 14%, for BBs 33%. DLTs were used in 95% of patients and BBs in 5%. Mean positioning time was shorter for DLT than BB (156±230 vs. 321±290 s). BRO was used in 54% of patients to check the correct positioning of the DLT. Desaturation occurred in 20% of all cases during OLV achieved through a DLT. Predicting factors of desaturation were dislocation (OR 2.03) and big size of DLT (OR 1.15). BRO use (OR 0.69) and left surgical side (OR 0.41) proved to be protective factors. Difficult airway prevalence was 16%; 10.8% predicted and 5.2% unpredicted. Conclusions DLT has a low malpositioning rate and is the preferred device to achieve OLV. BRO use recorded was unexpectedly low. The possibility of encountering a difficult airway is frequent, with an overall prevalence of 16%. Risk factors of desaturation are malposition and increased size of DLT. Left procedures and BRO use could lead to fewer episodes of desaturation.
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Affiliation(s)
- Nicola Langiano
- Department of Anesthesia and Intensive Care, University of Udine, Academic Hospital "S. M. della Misericordia", Udine, Italy
| | - Silvia Fiorelli
- Department of Anesthesiology and Intensive care, Sapienza University of Rome, Rome, Italy
| | - Cristian Deana
- Department of Anesthesia and Intensive Care, University of Udine, Academic Hospital "S. M. della Misericordia", Udine, Italy
| | - Antonio Baroselli
- Department of Anesthesia and Intensive Care, University of Udine, Academic Hospital "S. M. della Misericordia", Udine, Italy
| | - Elena Giovanna Bignami
- Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Carola Matellon
- Department of Anesthesia and Intensive Care, University of Udine, Academic Hospital "S. M. della Misericordia", Udine, Italy
| | - Livia Pompei
- UOC Anesthesia and ICM 1. Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
| | - Anna Tornaghi
- Department of Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Federico Piccioni
- Department of Anesthesia, Intensive Care and Palliative Care, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Remo Orsetti
- Anesthesia and ICM DPT of Pulmonary Diseases, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
| | | | - Noemi Sacchi
- School of Anesthesia and Intensive Care, University of Milan, Milan, Italy
| | - Rocco D'Andrea
- U.O. Anesthesia and ICM. A.U.O. Policlinico Sant'Orsola Malpighi, Bologna, Italy
| | - Luca Brazzi
- AOU "Città della Salute e della Scienza" di Turin, University of Turin, Turin, Italy
| | - Carlo Franco
- AOU "Città della Salute e della Scienza" di Turin, University of Turin, Turin, Italy
| | - Rosanna Accardo
- Division of Anesthesia, Department of Anesthesia, Endoscopy and Cardiology, Istituto Nazionale Tumori "Fondazione G. Pascale"-IRCCS, Naples, Italy
| | - Antonio Di Fuccia
- UOC Anesthesia and Postoperative ICM, Cardarelli Hospital, Naples, Italy
| | | | - Pasquale De Negri
- Department of Anesthesia, Intensive Care and Pain Medicine. IRCCS Centro di Riferimento Oncologico della Basilicata/OECI Clinical Cancer Center - Rionero in Vulture, Potenza, Italy
| | | | - Chiara Angeletti
- Operative Unit of Anesthesiology, Intensive Care and Pain Medicine, Civil Hospital G. Mazzini of Teramo, Teramo, Italy. Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Francesco Pugliese
- UOD Anesthesia and ICM of Organ Transplantation, DPT Paride Stefanini, Sapienza University of Rome, Rome, Italy
| | - Marco Valerio Micozzi
- Department of Anesthesiology and Intensive care, Sapienza University of Rome, Rome, Italy
| | - Domenico Massullo
- Department of Anesthesiology and Intensive care, Sapienza University of Rome, Rome, Italy
| | - Giorgio Della Rocca
- Department of Anesthesia and Intensive Care, University of Udine, Academic Hospital "S. M. della Misericordia", Udine, Italy
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One-lung Ventilation for Thoracic Surgery: Current Perspectives. TUMORI JOURNAL 2017; 103:495-503. [DOI: 10.5301/tj.5000638] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2017] [Indexed: 11/20/2022]
Abstract
One-lung ventilation (OLV) is an anesthesiological technique that is increasingly being used beyond thoracic surgery. This requires specific skills and knowledge about airway management, maintenance of gas exchange and prevention of acute lung injury. Sometimes maintaining adequate gas exchange and minimizing acute lung injury may be opposing processes. Parameters validated for OLV titration still have not been found, but a multimodal approach based on low tidal volume, end-expiratory pressure application and alveolar recruitment maneuvers is considered the best way to ensure protective ventilation and reduce lung damage. The purpose of this review is to analyze all these factors using the latest scientific evidence and the opinions of the most influential authors.
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Apneic oxygen insufflation decreases the incidence of hypoxemia during one-lung ventilation in open and thoracoscopic pulmonary lobectomy: A randomized controlled trial. J Thorac Cardiovasc Surg 2017; 154:360-366. [DOI: 10.1016/j.jtcvs.2017.02.054] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 02/04/2017] [Accepted: 02/19/2017] [Indexed: 12/12/2022]
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Weksler B. During one-lung ventilation, K.I.S.S.—Keep It Simple Surgeons. J Thorac Cardiovasc Surg 2017; 154:367-368. [DOI: 10.1016/j.jtcvs.2017.03.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 03/10/2017] [Indexed: 11/16/2022]
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Kaplan T, Ekmekçi P, Kazbek BK, Ogan N, Alhan A, Koçer B, Han S, Tüzüner F. Endobronchial intubation in thoracic surgery: Which side should be preferred? Asian Cardiovasc Thorac Ann 2015; 23:842-5. [PMID: 26080451 DOI: 10.1177/0218492315591105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIM This study was undertaken to compare the clinical performance of right versus left double-lumen endotracheal tubes placed without using fiberoptic bronchoscopy in thoracic surgery operations. METHODS This was a retrospective review of patients who were operated on in our institution between January 2013 and February 2014. We analyzed clinical performance in terms of hypoxia, hypercapnia, and adequate deflation of the lungs with both left- and right-sided double-lumen endotracheal tubes. RESULTS There were 80 patients with a mean age of 53.74 ± 15.59 years. Right-sided double-lumen tubes were used in 33 patients, and left-sided double-lumen tubes were used in 47. Perioperative hypoxi (p < 0.05), hypercapnia (p < 0.01), and inadequate deflation of the lung (p < 0.001) were found more frequently with the use of right-sided double-lumen endotracheal tubes. Arterial blood gas analyses in the post-anesthesia care unit showed that high pCO2 (>45 mm Hg), low pH (<7.36), and high lactate levels (>4 mmol L(-1)) were more frequent with right-sided double-lumen endotracheal tubes (p < 0.001). The incidence of atelectasis was greater (p < 0.001) and the duration of hospital stay was longer (p = 0.02) with the use of right-sided double-lumen endotracheal tubes. CONCLUSION Right-sided double-lumen endotracheal tubes resulted in poorer clinical performance. Therefore, a left-sided double-lumen endotracheal tube should be preferred in thoracic surgery operations when an appropriate size of fiberoptic bronchoscope is not available.
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Affiliation(s)
- Tevfik Kaplan
- Department of Thoracic Surgery, Ufuk University Faculty of Medicine, Ankara, Turkey
| | - Perihan Ekmekçi
- Department of Anesthesiology and Reanimation, Ufuk University Faculty of Medicine, Ankara, Turkey
| | - Baturay Kansu Kazbek
- Department of Anesthesiology and Reanimation, Ufuk University Faculty of Medicine, Ankara, Turkey
| | - Nalan Ogan
- Department of Chest Diseases, Ufuk University Faculty of Medicine, Ankara, Turkey
| | - Aslıhan Alhan
- Department of Statistics, Ufuk University Faculty of Arts and Sciences, Ankara, Turkey
| | - Bulent Koçer
- Department of Thoracic Surgery, Ankara Numune Teaching and Research Hospital, Ankara, Turkey
| | - Serdar Han
- Department of Thoracic Surgery, Ufuk University Faculty of Medicine, Ankara, Turkey
| | - Filiz Tüzüner
- Department of Anesthesiology and Reanimation, Ufuk University Faculty of Medicine, Ankara, Turkey
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Stafford M, Cappa A, Weyant M, Lara A, Ellis J, Weitzel NS, Puskas F. Treatment of Acute Silicoproteinosis by Whole-Lung Lavage. Semin Cardiothorac Vasc Anesth 2013; 17:152-9. [DOI: 10.1177/1089253213486524] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Acute silicoproteinosis is a rare disease that occurs following a heavy inhalational exposure to silica dusts. Clinically, it resembles pulmonary alveolar proteinosis (PAP); silica exposure is thought to be a cause of secondary PAP. We describe a patient with biopsy-confirmed acute silicoproteinosis whose course was complicated by acute hypoxemic respiratory failure requiring mechanical ventilation. Without clinical improvement despite antibiotic and steroid treatment, the patient was scheduled for whole-lung lavage under general anesthesia. Anesthetic challenges included double-lumen tube placement and single-lung ventilation in a hypoxic patient, facilitating lung lavage, and protecting the contralateral lung from catastrophic spillage.
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Affiliation(s)
| | | | | | | | - James Ellis
- University of Colorado Denver, Aurora, CO, USA
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Shelley B, Macfie A, Kinsella J. Anesthesia for Thoracic Surgery: A Survey of UK Practice. J Cardiothorac Vasc Anesth 2011; 25:1014-7. [DOI: 10.1053/j.jvca.2011.06.018] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2011] [Indexed: 11/11/2022]
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Abstract
PURPOSE OF REVIEW Hypoxemia during one-lung ventilation (OLV) has become less common; however, it may still occur in about 10% of cases. We review recent developments which may affect the incidence and treatment of hypoxemia during OLV. RECENT FINDINGS Changes in surgical techniques are affecting oxygenation during OLV. The increased use of the supine position may adversely affect the prevalence of hypoxemia, whereas the increased application of thoracoscopic techniques is limiting the treatment options. Treatment options such as global or selective recruitment maneuvers and drug effects of dexmedetomidine and epoprostenol on arterial oxygenation during OLV are discussed. Capnometry prior to, or early during OLV, may in fact be able to predict the degree of hypoxemia during OLV. Persistent controversies surrounding the effect of epidural anesthesia, ventilatory modalities and gravity are reviewed. SUMMARY Interesting concepts have emerged from case reports and small studies on the treatment and prediction of hypoxemia during OLV. Definitive studies on the most effective ventilatory mode remain elusive. End-organ effects of OLV are an exciting new concept that may shape clinical practice and research going forward.
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Bibliography. Current world literature. Thoracic anesthesia. Curr Opin Anaesthesiol 2011; 24:111-3. [PMID: 21321525 DOI: 10.1097/aco.0b013e3283433a20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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