Lung Separation in the Morbidly Obese Patient

Abstract

Lung separation techniques in the morbidly obese patient undergoing thoracic or esophageal surgery may be at risk of complications during airway management. Access to the airway in the obese patient can be a challenge because they have altered airway anatomy, including a short and redundant neck, limited neck extension and accumulation of fat deposition in the pharyngeal wall contributing to difficult laryngoscopy. Securing the airway is the first priority in these patients followed by appropriate techniques for lung separation with the use of a single-lumen endotracheal tube and a bronchial blocker or another alternative is with the use of a double-lumen endotracheal tube. This review is focused on the use of lung isolation devices in the obese patient. The recommendations are based upon scientific evidence, case reports or personal experience. Fiberoptic bronchoscopy must be used to place and confirm proper placement of a single-lumen endotracheal tube, bronchial blocker or double-lumen endotracheal tube.

Characteristics of anesthetic and surgical tactics in treatment of a patient with a giant thyroid mass in a cancer center (clinical case)

“…При этом интубация трахеи должна проводиться двухпросветной эндотрахеальной трубкой для раздельной вентиляции легких. Сложность данной манипуляции даже в типичных условиях не всегда безопасна для пациентов, а в некоторых случаях не может быть проведена вовсе [10]. Гигантская ЩЖ усугубляет ситуацию.…”

Thinking Outside the Tube: Expanding the Armamentarium of the Thoracic Anesthesiologist

“…These are 2 patient populations, however, who may derive the most benefit from BB use. 13,14 We hope, in future studies, that the authors will expand upon this work to include ventilatory metrics and other patient populations.…”

Data Interpretation on the Use of Double-Lumen Tube (DLT) Versus Bronchial Blocker (BB) for One-Lung Ventilation

“…When comparing the assessment scale values presented in the current meta-analysis, only the ratings of excellent/good/average seem to have been taken into account. Furthermore, we wonder which considerations were made to not include data from the study by Campos and Ueda 4 in the analysis mentioned in Fig 6 because the outcome data of interest for this analysis-malpositioning of the airway device -are available in that article.…”