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Li YL, Hang LH. Recommendations and considerations for speeding the collapse of the non-ventilated lung during single-lung ventilation in thoracoscopic surgery: a literature review. Minerva Anestesiol 2023; 89:792-803. [PMID: 37307029 DOI: 10.23736/s0375-9393.23.17272-5] [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: 06/13/2023]
Abstract
Video-assisted thoracoscopic thoracic surgery has the advantages of less physical damage, less postoperative pain, and a rapid recovery. Therefore, it is widely used in the clinic. The quality of nonventilated lung collapse is the key point of thoracoscopic surgery. Poor lung collapse on the operative side damages surgical exposure and prolongs the process of surgery. Therefore, it is important to achieve good lung collapse as soon as possible after opening the pleura. Over the past two decades, there have been reports of advances in research on the physiological mechanism of lung collapse and several kinds of techniques for speeding up lung collapse. This review will inform the advances of each technique, make recommendations for reasonable implementation and discuss their controversies and considerations.
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Affiliation(s)
- Yu-Lin Li
- Gusu School, Nanjing Medical University, The First People's Hospital of Kunshan, Kunshan, China
| | - Li-Hua Hang
- Gusu School, Nanjing Medical University, The First People's Hospital of Kunshan, Kunshan, China -
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Balkhy HH, Nisivaco S, Tung A, Torregrossa G, Mehta S. Does Intolerance of Single-Lung Ventilation Preclude Robotic Off-Pump Totally Endoscopic Coronary Bypass Surgery? INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2020; 15:456-462. [DOI: 10.1177/1556984520940462] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective Robotic off-pump totally endoscopic coronary artery bypass (TECAB) usually requires isolated single (right) lung ventilation to adequately expose the surgical site. However, in some patients, persistent oxygen desaturation may occur and conversion to cardiopulmonary bypass (CPB) or sternotomy may be necessary. We reviewed the characteristics and clinical outcomes in patients who did not tolerate single-lung ventilation during TECAB surgery. Methods After Institutional Review Board approval we reviewed 440 patients undergoing robotic TECAB at our institution between July 2013 and April 2019. Patients were separated into 2 groups based on their ability to tolerate single-lung ventilation during the procedure. Group 1 included patients able to tolerate single-lung ventilation and Group 2 were patients who required double-lung ventilation to tolerate the procedure. Early and mid-term outcomes were compared. Results Group 2 (121 patients) had higher Society of Thoracic Surgeons scores, higher body mass index, and more triple-vessel disease than Group 1 (319 patients). Group 2 had more bilateral internal mammary artery use, multivessel grafting, and longer operative times. One patient underwent conversion to sternotomy and 5 required CPB (all in Group 1). Intensive care unit and hospital length of stay were longer in Group 2. Observed/expected mortality did not differ between groups (1.06% in Group 2 vs 0.4% in Group 1; P = 0.215). At mid-term follow-up, cardiac-related/overall mortality and freedom from major adverse cardiac events were similar. Conclusions In our cohort, intolerance of single-lung ventilation did not preclude robotic off-pump TECAB. Double-lung ventilation is feasible during the procedure and may prevent conversions to sternotomy or use of CPB, resulting in excellent early and mid-term outcomes.
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Affiliation(s)
- Husam H. Balkhy
- Department of Cardiothoracic Surgery, University of Chicago Medicine, IL, USA
| | - Sarah Nisivaco
- Department of Cardiothoracic Surgery, University of Chicago Medicine, IL, USA
| | - Avery Tung
- Department of Anesthesia, University of Chicago Medicine, IL, USA
| | | | - Sachin Mehta
- Department of Anesthesia, University of Chicago Medicine, IL, USA
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Zhang C, Yue J, Li M, Jiang W, Pan Y, Song Z, Shi C, Fan W, Pan Z. Bronchial blocker versus double-lumen endobronchial tube in minimally invasive cardiac surgery. BMC Pulm Med 2019; 19:207. [PMID: 31706317 PMCID: PMC6842514 DOI: 10.1186/s12890-019-0956-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 10/10/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To compare the therapeutic value of a bronchial blocker (BB) with a double-lumen tube (DLT) in minimally invasive cardiac surgery (MICS). METHODS Sixty patients who underwent MICS were randomized to use either a DLT (Group D, n = 30) or a BB (Group B, n = 29; one failed was omitted). The following data were collected: time of intubation and tube localization; incidence of tube displacement; postoperative sore throat and hoarseness; time of cardiopulmonary bypass; maintenance time for SpO2 < 90% (PaCO2 < 60 mmHg); mean arterial pressure and heart rate; SpO2, PaO2, PaCO2, EtCO2, mean airway pressure, and airway peak pressure; surgeons' satisfaction with anesthesia; and short-term complications. RESULTS The times of intubation and tube localization were significantly longer in Group B than in Group D (P < 0.05). Patients in Group B exhibited significantly lower incidence of tube displacement, postoperative sore throat, and hoarseness when compared with patients in Group D (P < 0.05). Mean arterial pressure and heart rate were significantly lower in Group B than in Group D after tracheal intubation (P < 0.05). The mean airway pressure and airway peak pressure were significantly lower in Group B than in Group D after one-lung ventilation (P < 0.05). SpO2 and PaO2 in Group B were significantly higher than in group D after cardiopulmonary bypass (P < 0.05). No short-term postoperative complications were observed in patients of Groups B and D during 3 month follow-up. CONCLUSION BB can be a potential alternative to the conventional DLT for lung isolation in MICS. TRIAL REGISTRATION ChiCTR1900024250, July 2, 2019.
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Affiliation(s)
- Chuncheng Zhang
- Department of Anesthesiology, The Second Hospital of Jilin University, No.218 Ziqiang Street, Nanguan District, Changchun, 130041, Jilin province, China
| | - Jing Yue
- Department of Anesthesiology, The Second Hospital of Jilin University, No.218 Ziqiang Street, Nanguan District, Changchun, 130041, Jilin province, China
| | - Mingyue Li
- Department of Anesthesiology, The Second Hospital of Jilin University, No.218 Ziqiang Street, Nanguan District, Changchun, 130041, Jilin province, China
| | - Wei Jiang
- Department of Anesthesiology, The Second Hospital of Jilin University, No.218 Ziqiang Street, Nanguan District, Changchun, 130041, Jilin province, China
| | - Yu Pan
- Yanbian University, Yanbian, 130000, Jilin province, China
| | - Zhimin Song
- Department of Anesthesiology, The Second Hospital of Jilin University, No.218 Ziqiang Street, Nanguan District, Changchun, 130041, Jilin province, China
| | - Cailian Shi
- Department of Anesthesiology, The Second Hospital of Jilin University, No.218 Ziqiang Street, Nanguan District, Changchun, 130041, Jilin province, China
| | - Weixuan Fan
- Department of Intensive Care Unit, The Second Hospital of Jilin University, Changchun, 130041, Jilin province, China
| | - Zhenxiang Pan
- Department of Anesthesiology, The Second Hospital of Jilin University, No.218 Ziqiang Street, Nanguan District, Changchun, 130041, Jilin province, China.
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Sixt S, Aubin H, Kalb R, Rellecke P, Lichtenberg A, Albert A. Continuous Procedural Full-Lung Ventilation During Minimally Invasive Coronary Bypass Grafting. Ann Thorac Surg 2017; 104:1994-2000. [PMID: 28760476 DOI: 10.1016/j.athoracsur.2017.05.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 04/11/2017] [Accepted: 05/05/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND In the past, minimally invasive cardiac surgery (MICS)- coronary artery bypass graft surgery (CABG) alternatives have been introduced that dramatically reduce the invasiveness of standard operative procedures while still showing excellent clinical outcomes. However, in patients with high morbidity, reduced lung function impeding single-lung ventilation is one of the major concerns for MICS-CABG procedures, although those patients might reap the largest benefit from a procedure of reduced invasiveness. METHODS Here, we describe a simple surgical technique-the fan technique-that allows for continuous full-lung ventilation with unimpeded surgical view during common MICS-CABG procedures. To evaluate the procedural feasibility of this technique, we analyzed intraoperative ventilation measurements of 22 consecutive MICS-CABG patients in whom the fan technique was used. RESULTS This study demonstrates a significant improvement of standard respiratory measurements during procedural full-lung ventilation using the fan technique as compared with conventional single-lung ventilation (ventilation pressure 21.4 ± 3.2 versus 26.6 ± 3 mbar, p < 0.001; respiratory rate 13.1 ± 1.4 versus 14.4 ± 2.2 breaths per minute, p < 0.001; minute volume 7.4 ± 1.1 versus 6.2 ± 1 L/min, p < 0.0001; Pao2 during ventilation 294.9 ± 74.6 versus 153.2 ± 71 mm Hg, p < 0.0001). CONCLUSIONS The presented technique may not only enable us to perform MICS-CABG procedures in patients not suitable for single-lung ventilation owing to reduced pulmonary function, but also may soon also become a standard procedure for MICS-CABG surgery, especially with regard to procedures involving complex and time-consuming multivessel revascularizations. However, further studies are strongly warranted to assess whether the fan technique may also decrease postoperative pulmonary complications and benefit clinical outcome indicators.
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Affiliation(s)
- Stephan Sixt
- Department of Anesthesiology, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Hug Aubin
- Department of Cardiovascular Surgery, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany.
| | - Robert Kalb
- Department of Anesthesiology, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Philipp Rellecke
- Department of Anesthesiology, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany; Department of Cardiovascular Surgery, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Artur Lichtenberg
- Department of Cardiovascular Surgery, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Alexander Albert
- Department of Cardiovascular Surgery, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
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Li Q, Zhang X, Wu J, Xu M. Two-minute disconnection technique with a double-lumen tube to speed the collapse of the non-ventilated lung for one-lung ventilation in thoracoscopic surgery. BMC Anesthesiol 2017; 17:80. [PMID: 28619111 PMCID: PMC5472948 DOI: 10.1186/s12871-017-0371-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 05/31/2017] [Indexed: 12/13/2022] Open
Abstract
Background Thoracic surgery requires the effective collapse of the non-ventilated lung. In the majority of cases, we accomplished, accelerated lung collapse using a double-lumen tube (DLT). We hypothesized that using the two-minute disconnection technique with a DLT would improve lung collapse during subsequent one-lung ventilation. Methods Fifty patients undergoing thoracoscopic surgery with physical classification I or II according to the American Society of Anesthesiologists were randomly divided into two groups for respiratory management of one-lung ventilation (OLV). In group N, OLV was initiated after the DLT was disconnected for 2 min; the initiation time began when the surgeon made the skin incision. In group C, OLV was initiated when the surgeon commenced the skin incision and scored the quality of lung collapse (using a four-point ordinal scale). The surgeon’s satisfaction or comfort with the surgical conditions was assessed using a visual analogue scale. rSO2 level, mean arterial pressure, pulse oxygen saturation, arterial blood gas analysis, intraoperative hypoxaemia, intraoperative use of CPAP during OLV, and awakening time were determined in patients at the following time points: while inhaling air (T0), after anaesthesia induction andinhaling 100% oxygen in the supine position under double lung ventilation for five mins (T1), at two mins after skin incision (T2), at ten mins after skin incision (T3), and after the lung recruitment manoeuvres and inhaling 50% oxygen for five mins (T4). Results The two-minute disconnection technique was associated with a significantly shorter time to total lung collapse compared to that of the conventional OLV ventilation method (15 mins vs 22 mins, respectively; P < 0.001), and the overall surgeon’s satisfaction was higher (9 vs 7, respectively; P < 0.001). At T2, the PaCO2, left rSO2 and right rSO2 were higher in group N than in group C. There were no statistically significant differences between the incidence of intraoperative hypoxaemia and intraoperative use of CPAP during OLV (10% vs 5%, respectively; P = 1.000), duration of awakening (18 mins vs 19 mins, respectively; P = 0.616). Conclusions A two-minute disconnection technique using a double-lumen tube was used to speed the collapse of the non-ventilated lung during one-lung ventilation for thoracoscopic surgery. The surgeon was satisfied with the surgical conditions. Trial registration Chinese Clinical Trial Registry number, ChiCTR-IPR-17010352. Registered on Jan, 7, 2017.
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Affiliation(s)
- Qiongzhen Li
- Department of Anesthesiology of Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, 200030, China
| | - Xiaofeng Zhang
- Department of Anesthesiology of Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, 200030, China
| | - Jingxiang Wu
- Department of Anesthesiology of Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, 200030, China
| | - Meiying Xu
- Department of Anesthesiology of Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, 200030, China.
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Abstract
Over the past two decades there has been a steady evolution in the practice of adult cardiac surgery with the introduction of “off-pump” surgery. However, respiratory complications remain a leading cause of postcardiac surgical morbidity and can prolong hospital stays and increase costs. The high incidence of pulmonary complications is in part due to the disruption of normal ventilatory function that is inherent to surgery in the thoracic region. Furthermore, patients undergoing such surgery often have underlying illnesses such as intrinsic lung disease (e.g., chronic obstructive pulmonary disease) and pulmonary dysfunction secondary to cardiac disease (e.g., congestive heart failure) that increase their susceptibility to postoperative respiratory problems. Given that many patients undergoing cardiac surgery are thus susceptiple to pulmonary complications, it is remarkable that more patients do not suffer from them during and after cardiac surgery. This is to a large degree because of advances in anesthetic, surgical and critical care that, for example, have reduced the physiological insults of surgery (e.g., better myocardial preservation techniques) and streamlined care in the immediate postoperative period (e.g., early extubation). Moreover, the development of minimally invasive surgery and nonbypass techniques are further evidence of the attempts at reducing the homeostatic disruptions of cardiac surgery. This review examines the available information on the incidences, consequences, and treatments of postcardiac surgery respiratory complications.
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Affiliation(s)
- Charles Weissman
- Department of Anesthesiology and Critical Care Medicine, Hadassah-Hebrew University School of Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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Kreft T, Zardo P, Busk H, Kretzschmar M, Kozian A, Schilling T. Modern Bronchial Blockers in Thoracic Surgery. CURRENT ANESTHESIOLOGY REPORTS 2016. [DOI: 10.1007/s40140-016-0162-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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A comparison of the disconnection technique with continuous bronchial suction for lung deflation when using the Arndt endobronchial blocker during video-assisted thoracoscopy: A randomised trial. Eur J Anaesthesiol 2016; 32:411-7. [PMID: 25564782 DOI: 10.1097/eja.0000000000000194] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The use of the Arndt endobronchial blocker has not gained widespread acceptance during video-assisted thoracoscopic surgery (VATS) because of its high cost and longer time to operative lung collapse especially in patients with chronic obstructive pulmonary disease (COPD). The use of a ventilator disconnection technique has been shown to produce a comparable degree of lung collapse when used with either a double-lumen tube or an Arndt endobronchial blocker. OBJECTIVE We hypothesised that the use of bronchial suction through the suction port of the endobronchial blocker would be associated with a comparable time to achieve optimum lung collapse as the disconnection technique. DESIGN A randomised, double-blind study. SETTING Single university hospital. PARTICIPANTS Fifty-eight patients with spontaneous pneumothorax scheduled for elective VATS using the Arndt endobronchial blocker for one-lung ventilation (OLV). INTERVENTIONS Patients were randomly assigned to one of two groups (n = 29 per group) to deflate the operative lung with either disconnection of the endotracheal tube from the ventilator for 60 s prior to inflation of the endobronchial blocker or connection of a suction pressure of -30 cmH2O to the suction port of the endobronchial blocker through the barrel of a 1 ml syringe. MAIN OUTCOME MEASURES The primary outcome was the time to total lung collapse. Secondary outcomes included surgeon rating of lung collapse, overall surgeon satisfaction, need for further fibreoptic bronchial suction manoeuvres and intraoperative hypoxaemia. RESULTS The bronchial suction technique was associated with a significantly shorter time to total lung collapse than the disconnection method [93 (95% confidence interval, 95% CI 81.3 to 103.7) vs. 197 (95% CI 157.4 to 237) s respectively; P < 0.001]. Both the disconnection and bronchial suction groups had a comparable surgical rating of excellent lung collapse 40 min after the start of OLV (65.5 vs. 79.3%, respectively; P = 0.24), overall surgeon satisfaction [median (interquartile range, IQR) 9 (8 to 10) vs. 9 (8 to 10) respectively; P = 0.90] and intraoperative hypoxaemia (3.5 vs. 0%, respectively; P = 0.32). No patient in the bronchial suction group needed further manoeuvres to collapse the surgical lung. Moreover, the presence of COPD showed a significant positive correlation with the time to total lung collapse (Spearman r = 0.564; P < 0.001). CONCLUSION The use of continuous bronchial suction through the lumen of the Arndt blocker offers an effective method to accelerate lung collapse. TRIAL REGISTRATION Clinicaltrials.gov identifier: NCT02030795.
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Left double-lumen tube with or without a carinal hook: A randomised controlled trial. Eur J Anaesthesiol 2016; 32:418-24. [PMID: 25489763 DOI: 10.1097/eja.0000000000000201] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Left double-lumen tracheal tubes (DLTs), with or without a hook to engage the carina, remain the standard device for lung isolation during anaesthesia. OBJECTIVE The purpose of the study was to compare these DLTs with and without a hook. DESIGN A randomised, controlled, single-blinded study. SETTING University hospital. PARTICIPANTS One hundred and eighty-four patients undergoing lung resection. MAIN OUTCOME MEASURE Time required to position the tube from the introduction of the tube into the mouth to confirmation of correct placement in the supine position. RESULTS Baseline characteristics were well balanced between the groups. Time to place DLTs was similar in both groups: median (interquartile range, IQR) 81.0 (50.0 to 146.2) s for DLTs without a hook and 67.5 s (45.0 to 138.7) for DLTs with a hook (P = 0.43). The incidence of adequate position at the first attempt was 68.5% in the No hook group and 69.6% in the Hook group (P = 0.95). Patients in both groups suffered similar incidences of sore throat at day 0 and day 1 (P = 0.80 and P = 0.20, respectively). No major lesion of the vocal cords or tracheobronchial tree was discovered and the incidence of minor lesions was similar in both groups. CONCLUSION When a DLT is used, the presence of a carinal hook gives neither advantage nor added complications. TRIAL REGISTRATION ClinicalTrials.gov, NCT00969683.
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Clayton-Smith A, Bennett K, Alston RP, Adams G, Brown G, Hawthorne T, Hu M, Sinclair A, Tan J. A Comparison of the Efficacy and Adverse Effects of Double-Lumen Endobronchial Tubes and Bronchial Blockers in Thoracic Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Trials. J Cardiothorac Vasc Anesth 2015; 29:955-66. [DOI: 10.1053/j.jvca.2014.11.017] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Indexed: 11/11/2022]
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Young Yoo J, Hee Kim D, Choi H, Kim K, Jeong Chae Y, Yong Park S. Disconnection Technique With a Bronchial Blocker for Improving Lung Deflation: A Comparison With a Double-Lumen Tube and Bronchial Blocker Without Disconnection. J Cardiothorac Vasc Anesth 2014; 28:904-7. [DOI: 10.1053/j.jvca.2013.07.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Indexed: 11/11/2022]
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Takahashi M, Rhee AJ, Filsoufi F, Silvay G, Reddy RC. Anesthetic and technical considerations in redo coronary artery bypass surgery using sternal-sparing approaches. J Cardiothorac Vasc Anesth 2012; 27:315-8. [PMID: 22770757 DOI: 10.1053/j.jvca.2012.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Indexed: 11/11/2022]
Affiliation(s)
- Mitsuko Takahashi
- Department of Cardiothoracic Surgery, Mount Sinai Medical Center, New York, NY 10029, USA
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Ender J, Brodowsky M, Falk V, Baunsch J, Koncar-Zeh J, Kaisers UX, Mukherjee C. High-Frequency Jet Ventilation as an Alternative Method Compared to Conventional One-Lung Ventilation Using Double-Lumen Tubes During Minimally Invasive Coronary Artery Bypass Graft Surgery. J Cardiothorac Vasc Anesth 2010; 24:602-7. [PMID: 20056443 DOI: 10.1053/j.jvca.2009.10.029] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2009] [Indexed: 11/11/2022]
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