Current Practice Issues in Thoracic Anesthesia

Abstract

This review discusses the present strategies in lung separation, the various types of double-lumen tubes (DLTs), and the use of bronchial blockers (BBs). Methods of selecting the correct DLT size and the role of videolaryngoscopy in placing a DLT are reviewed. Mechanisms whereby inhaled anesthetics may be protective during one-lung ventilation (OLV) are highlighted. The risk and prevention of fire during thoracic procedures are discussed.

Utilization of an Endobronchial Blocker Through a Double-Lumen Tube as Rescue for Inadequate One-Lung Ventilation

“…One-lung ventilation (OLV) is necessary during many thoracic surgical procedures to aid in surgical visualization, and failure to provide OLV can be especially prohibitive in minimally invasive thoracic surgeries. Multiple strategies exist for establishing OLV, including double-lumen endotracheal tubes (DLT) or the use of an endobronchial blocker (EBB) [1][2][3] through a single-lumen endotracheal tube (SLT). Selection between a DLT or EBB is multifactorial, with ease of intubation, 4,5 variant anatomy, 6 site of surgical procedure, and provider experience being some of the considerations.…”

Tracheal Bronchus and Successful Right-Sided Isolation With a Bronchial Blocker

“…Traditionally, double-lumen endotracheal tubes (DLT) have served as the gold standard for lung isolation. [1][2][3] However, placement of a DLT can be technically challenging and nearly impossible in certain patients or clinical scenarios such as patients with difficult airways, necessitating the use of a single lumen tube (SLT) and a bronchial blocker (BB) for lung isolation. 3 In patients with abnormal bronchial anatomy, in particular, those with tracheal bronchus, the efficacy of lung isolation obtained with a bronchial blocker is likely to be inadequate.…”

“…[1][2][3] However, placement of a DLT can be technically challenging and nearly impossible in certain patients or clinical scenarios such as patients with difficult airways, necessitating the use of a single lumen tube (SLT) and a bronchial blocker (BB) for lung isolation. 3 In patients with abnormal bronchial anatomy, in particular, those with tracheal bronchus, the efficacy of lung isolation obtained with a bronchial blocker is likely to be inadequate. Previous reports describe incidental discovery of a tracheal bronchus during postintubation bronchoscopy for surgical cases requiring right-sided isolation, leading to a change in airway management from SLT + BB to DLT.…”