Failure to Isolate the Right Lung with an EZ-Blocker

Obaidi, Rafee A.; O’Hear, Kelley E.; Kulkarni, Vivek; Brodsky, Jay B.; Shrager, J.

doi:10.1213/xaa.0000000000000056

Cited by 6 publications

(5 citation statements)

References 4 publications

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“…Since bronchial blockers have a thinner lumen, lung deflation times may be longer. In addition, proximal misplacement off the right upper lobe may cause insufficient lung deflation [10]. Yoo et al stated that in cases where spontaneous collapse was achieved with BB, the surgical exposure was not equivalent to that with DLT.…”

Section: Discussionmentioning

confidence: 99%

Comparison of EZ blocker and left double-lumen endotracheal tube for one lung ventilation in minimally invasive cardiac surgery

Bermede¹

2021

Journal of Surgery and Medicine

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Section: Discussionmentioning

confidence: 99%

Comparison of EZ blocker and left double-lumen endotracheal tube for one lung ventilation in minimally invasive cardiac surgery

Bermede¹

2021

Journal of Surgery and Medicine

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“…[4][5][6] Another option in difficult airway scenarios is bronchial blocker but in pts with serious obstructive disease or atypical bronchial anatomy, blocker may not produce effective lung isolation. 7 Also, the use of bronchial blocker is restricted due to inability to clear secretions, visualisation of bronchial anatomy of nondependent lung and accurate delivery of continuous positive airway pressure (CPAP) to nondependent lung, with use of bronchial blockers there are high incidences of displacement during patient's positioning. 8 With restricted mouth opening in our patient oral intubation was not possible, hence, nasal intubation or tracheostomy were the only options.…”

Section: Discussionmentioning

confidence: 99%

Nasal intubation with bronchial blocker in a patient with difficult airway for thoracoscopic surgery

Koli¹,

Kadakia²,

Latkar³

et al. 2021

Int J Res Med Sci

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We describe a case report of a 49 years old male, a case of Carcinoma tongue with one finger mouth opening operated multiple times, currently presented with pleural based soft tissue lesion in lower lobe of left lung with query metastasis posted for video assisted thoracoscopy surgery (VATS) SOS open thoracotomy and wedge resection of the lesion. Considering difficult airway due to restricted mouth opening we opted for an awake nasal fiberoptic intubation followed by general anaesthesia. One lung ventilation was achieved with CoopdechTM bronchial blocker type A with standard cuff size in left main stem bronchus. Postoperative course of patient was uneventful. In this case report we highlight the importance of use of fiberoptic bronchoscope and bronchial blocker for lung deflation in the management of difficult airway in VATS, as incomplete deflation of the nondependent lung during VATS can lead to poor surgical exposure and inadequate space for surgical manipulation which in turn can compromise the success of the procedure, and may possibly lead to conversion into an open approach.

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“…This benefit is especially apparent in dogs in which cranially located right cranial lobar bronchi (right tracheal bronchus) often makes complete right sided blockade very challenging to impossible with other OLV devices that rely on direct blockade of the bronchial orifice. A previous case report described the inability to effectively block the right side because the right cranial bronchus was originating cranial to the carina of a dog …”

Section: Discussionmentioning

confidence: 99%

“…In general, the human tracheobronchial tree is quite different from that of dogs with a much shorter trachea length (~10‐11 cm) and a relatively low (0.5%–1%) incidence of a right cranial lobar bronchus that emanates from a position cranial to the carina, a so‐called tracheal bronchus . A right‐sided tracheal bronchus can make blockade of the right cranial lung lobe very challenging with endobronchial blockers . In contrast, the canine trachea in one analysis of mostly smaller breeds of dog (<20 kg) was a mean of 17.1 to 17.5 cm in length .…”

Section: Introductionmentioning

confidence: 99%

Cadaveric evaluation of fluoroscopy‐assisted placement of one‐lung ventilation devices for video‐assisted thoracoscopic surgery in dogs

et al. 2019

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Objective To evaluate the feasibility of fluoroscopy‐assisted placement of one‐lung ventilation (OLV) devices in dogs. Study design Experimental study. Sample population Canine cadavers (n = 8) weighing between 20.2 and 37.4 kg. Methods Thoracoscopic access with a two‐port approach was established to evaluate bilateral lung ventilation patterns. Advancement of a left‐sided Robertshaw double‐lumen endobronchial tube (DLT) and the EZ‐blocker (EZ) were evaluated under direct fluoroscopic guidance. Each dog also underwent bronchoscopy‐assisted placement of an Arndt endobronchial blocker (EBB). Time to initial placement, success of creating complete OLV (after initial placement attempt and after up to two repositionings), and ease of placement score were recorded. Device position was evaluated bronchoscopically after each fluoroscopy‐assisted placement attempt. Results Time to initial placement was significantly shorter for EZ than for DLT and EBB. The rate of successful placement after up to two repositioning attempts was 87.5%, 87.5%, and 100.0% on the right and 87.5%, 100.0%, 100.0% on the left for DLT, EZ, and EBB, respectively, and was not different between devices. Ease of placement scores were significantly higher for DLT compared with EZ and EBB on both the left and the right sides. Conclusion Fluoroscopy‐assisted placement of DLT and EZ appears feasible in canine cadavers. EZ‐blocker placement was efficient and technically easier than DLT, but positioning must be adapted for dogs. Bronchoscopy‐assisted placement of EBB remains highly successful. Clinical significance Fluoroscopy‐assisted placement of EZ and DLT is a useful alternative to bronchoscopy‐assisted placement of these OLV devices.

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Failure to Isolate the Right Lung with an EZ-Blocker

Cited by 6 publications

References 4 publications

Comparison of EZ blocker and left double-lumen endotracheal tube for one lung ventilation in minimally invasive cardiac surgery

Comparison of EZ blocker and left double-lumen endotracheal tube for one lung ventilation in minimally invasive cardiac surgery

Nasal intubation with bronchial blocker in a patient with difficult airway for thoracoscopic surgery

Cadaveric evaluation of fluoroscopy‐assisted placement of one‐lung ventilation devices for video‐assisted thoracoscopic surgery in dogs

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