Effects of bronchial blockers on one-lung ventilation in general anesthesia

Abstract

Background: Double-lumen bronchial tubes (DLBT) and bronchial blockers (BB) are commonly used in the anesthesia for clinical thoracic surgery. But there are few systematic clinical comparisons between them. In this study, the effects of BB and DLBT on one-lung ventilation (OLV) are studied.Methods: The 200 patients with thoracic tuberculosis undergoing thoracic surgery, were randomly assigned to group A (DLBT) and group B (BB). Intubation time, hemodynamic changes (mean arterial pressure [MAP], heart rate [HR]), and arterial blood gas indicators (arterial partial pressure of carbon dioxide [PaCO2], arterial partial pressure of oxygen [PaO2], airway plateau pressure [Pplat], and airway peak pressure [Ppeak]) at 4 time points were recorded. Complications such as hoarseness, pulmonary infection, pharyngalgia, and surgical success rate were also evaluated postoperatively.Results: Intubation times were shorter in group B. Both MAP and HR in group A were significantly higher 1 minute after intubation than before, but also higher than those in group B. PaO2 levels were lower in both groups during (OLV) than immediately after anesthesia and after two-lung ventilation (TLV), with PaO2 being lower after 60 minutes of OLV than after 20 minutes of OLV. Furthermore, at both points during OLV, PaO2 was lower in group A than in group B. No significant differences in PaCO2 were found between the 2 groups. Ppeak and Pplat were increased in both groups during OLV, with both being higher in group A than in group B. The incidence of postoperative hoarseness, pulmonary infection, and pharyngalgia were lower in group B. There was no significant difference in the success rate of operation between the 2 groups.Conclusions: Compare with using DLBT, implementation of BB in general anesthesia has less impact on hemodynamics, PaO2 and airway pressures, and achieves lower incidence of postoperative complication.

Clinical guidelines on perioperative management strategies for enhanced recovery after lung surgery

“…Correctable causes of arrhythmia, if present, should be identified. The airway must be kept patent ensure proper ventilation (61,62). Intraoperative application of bronchodilators can reduce bronchospasm (63)(64)(65).…”

Extraluminal Placement of a Bronchial Blocker Compared with Carbon Dioxide Artificial Pneumothorax in Infants Undergoing Video-Assisted Thoracoscopic Surgery

“…Zheng et al and Yan et al reported that the use of a bronchial blocker for lung collapse provides an adequate surgical field of vision. 9,16) The MAP of group B was significantly lower than that of group A at T2 and T3. The incidence of intraoperative hypotension in group B was significantly higher than that in group A. Mohtar et al also reported no significant change in blood pressure before, during, or after bronchial blocker use.…”

“…Zheng et al and Yan et al reported that the use of a bronchial blocker for lung collapse provides an adequate surgical field of vision. 9 , 16) …”

The association between double-lumen tube versus bronchial blocker and postoperative pulmonary complications in patients after lung cancer surgery

“…Prolonged stimulation of the bronchus by DLT may also contribute to the increasing risk of PPCs. The effects of BB and DLT for lung isolation on PPCs had been evaluated, but with conflicting results (13,14). In the recent randomized controlled trial, authors reported that implementation of BB for patients with thoracic tuberculosis undergoing thoracic-approach debridement had lower incidence of postoperative complications including hoarseness, pharyngalgia and pulmonary infection within 1 week after surgery when compared with DLT (13).…”

“…The BB is inserted inside a SLT previously placed into the trachea, while the blood or secretions from the operative lung may expose the contralateral lung to contamination. Several studies of different airway devices (DLT or BB) for lung isolation on PPCs showed different results ( 13 , 14 ). A randomized controlled study showed that implementation of BB has lower incidence of pulmonary infection within 1 week after thoracic surgery than DLT ( 13 ).…”