Endobronchial tubes – a case for re‐evaluation

Abstract

Summary An endobronchial tube (Macintosh‐Leatherdale) was used to secure the airway for a tracheal resection and end‐to‐end anastomosis. This lung separation device enabled insertion of both a fibreoptic bronchoscope and a tube exchange catheter. These were required after the trachea was transected and re‐anastomosis proved surgically difficult. The airway exchange catheter allowed for jet ventilation and later a tube change when an emergency occurred. Options and management issues for tracheal surgery and lung separators are discussed. A case is made for a re‐evaluation of endobronchial tubes both as a useful conduit for modern airway instruments and as an alternative to small double‐lumen tubes for the increasing population of obese patients weighing > 100 kg, requiring thoracic surgery.

Pneumopericardium:two case reports and a review

“…2,5,31 Volutrauma because of an unexpectedly narrow tracheal lumen and consequent inability to completely exhale was most likely responsible for the pneumopericardium in the second case. We and others [45][46][47][48][49] have successfully used an airway exchange catheter and jet ventilation for management of even relatively tight upper and lower airway stenoses. However, when using such a technique, it is imperative to avoid volutrauma by Figure 1 utilising a slow ventilatory pattern and to monitor chest wall excursion to ensure adequate expiration before the next inspiration is administered.…”

Anesthetic Management of a Patient With Central Airway Compression Due to Posterior Mediastinal Mass

“…They were used in the past for lung separation but they were substituted with double lumen tubes and bronchial blockers in modern thoracic anesthesia. However, SLEBT can have role in particular clinical settings for airway management in the surgery of distal trachea and main bronchi and for lung separation in obese patients 10 . Modified SLEBT was successfully used for airway management in severe tracheobronchial compression 11 .…”

Lung separation and the difficult airway

“…Special double-cuffed, single-lumen endobronchial tubes (EBTs) were previously available for this purpose, 3 but they have been replaced by DLTs and BBs. 45 EBTs have a narrow bronchial cuff and a relatively short distance from the proximal edge of that cuff to the distal tip of the tube. This design reduces the chance of upper-lobe obstruction.…”