Density spectral array of BIS VISTA monitoring system during Wada study
Juan Luis Fernández-Candil · 2016
Title: Double lumen tubes with bronchial blockers for lobar isolation in infection lung surgery.Authors: Granell M. 1,2, Peris-Montalt R.1, Nieto Conejos S. 1, Dolz L.M. 1, Almenara Almenara N. 1, de Andres J1,2.Institutions: 1. Anesthesiology, Critical Care and Pain Relief Department (University General Hospital of Valencia). 2. University of Valencia, Spain (Medicine, Anesthesiology Department).Introduction.Healthy lung or lobes isolation is an absolute indication for selected surgical settings and medical conditions such as thoracic surgery in lung infection. Different methods have been described and used to isolate 1 lung or lobe/s, including the double-lumen endotracheal tube (DLT) and a variety of bronchial blockers (BBs). We present two cases with lung infection in which the isolation was made by combining DLT + BB.Case Report.Case 1: 22-years-old man diagnosed with lungaspergilloma within the residual tuberculous cavity in the upper left lobe. The surgeon requested selective resection of this lobe. Case 2: 43-year-old man diagnosed with lung abscess in the left lower lobe with suspected neoplasia, proposed to lobectomy. In both, airway management was a combination of left DLT with aBB, using the flexible fiberoptic as a guide to place the BB throught the endobronchial lumen of DLT. In case 1 a Cohen BB was used; in case 2, an Arndt BB was chosen. After BB placement, the corresponding lobes were isolated and remained so until before the bronchus section. This method of isolation prevented in both cases the spread of infection to healthy areas of the lung during the perioperative surgical manipulation obtaining a good result clinical-surgical.Discussion.The fine balance between providing satisfactory surgical exposure and maintaining adequate oxygenation is a challenge, but in these cases, isolation was even more essential. For this, the anesthesiologist has several devices for airway management. Some experts recommend DLT for lung isolation for its shorter insertion and less need for repositioning1,2; Others exposed that the BB have lower complication rate with the same efficiency as DL2,3. However, it is also described the combination of placing both devices (DLT and BB)4, as presented in our cases, providing an excellent isolation and results.References1.tNarayanaswamy M, et al. Choosing a lung isolation device for thoracic surgery: a randomized trial of three bronchial blockers versus double lumen tubes. AnestAnalg 2009; 108(4):1097-101.2.tClayton-Smith A, et al. 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 fo randomized controlled trials. J CardiothoracVascAnesth 2015; 29(4):955-66.3.tKosarek L, et al. Effective use of bronchial blockers in lung isolation surgery: an analysis of 130 cases. Ochsner J 2013; 13(3):389-93.4.tMarsunami S, et al. Combination of a double lumen tracheal tuve and bronchial blocker for a patient with continuous bleeding due to invasive lung infection. J Clin Anesth 2015; 27(5):430-1.