Use of the Arndt wire-guided endobronchial blocker via nasal for one-lung ventilation in patient with anticipated restricted mouth opening for esophagectomy

Abstract

Functional separation of the lungs may be accomplished by several methods. Patient with restricted mouth opening has limited options for one-lung ventilation. We report the use of wire-guided endobronchial blockade, a new tool for achieving one-lung ventilation in a patient with restricted mouth opening requiring nasotracheal, fiberoptic intubation for esophagectomy and reconstruction with gastric tube substitution.

Airway strategies for lung isolation in a patient with high-velocity nail gun injuries to the right cardiac ventricle and floor of the mouth: a case report

“…As described in this case, when lung separation is critical and the orotracheal route is unsuccessful or not possible, we advocate nasotracheal intubation using a standard nasal endotracheal tube and deploying an independent bronchial blocker such as the wire-guided Arndt endobronchial blocker, Cohen™ endobronchial blocker or Fuji™ endobronchial blocker. The Arndt® blocker for nasotracheal intubation and lung isolation has been reported [11,12] but not in the context of penetrating chest trauma. A common problem for the thoracic anaesthetist is determining bronchoscope-endotracheal tube-blocker compatibility; therefore, a list of compatible endotracheal tubes, bronchoscopes and bronchial blockers is presented in Table 1.…”

One lung ventilation in a patient with an upper and lower airway abnormality

“…Bronchial blockers have been used to achieve OLV in patients with restricted mouth opening[23] and in paediatric patients for scoliosis surgery. [4] Bronchial blockers have an established role in patients with abnormal tracheobronchial tree and requiring thoracic surgery.…”

“…As described by several authors as the technique of choice,[36] we also secured the patients airway with a single-lumen nasotracheal tube under fiberoptic bronchoscope guidance. We opted for fiberoptic bronchoscope–assisted nasotracheal intubation, as it conforms to the natural airway passages and is relatively easier than orotracheal intubation in patients with restricted mouth opening.…”

“…We did not prefer a DLT in our patient due to the following reasons: 1) Nasal intubation is not easy with a DLT due to its large outer diameter and the distal curvature. [3] 2) In patients with a difficult airway (Mallampati grade view 3 or 4), restricted mouth opening, limited neck extension, etc, it is difficult to place a DLT as it is bulkier and more rigid than a single-lumen endotracheal tube. [78] 3) In our patient, there was, in addition, distortion of the tracheobronchial tree; hence, placement of a DLT would have posed additional difficulties.…”

“…[1] Earlier on, some reports have described the use of bronchial blockers for providing OLV in patients with restricted mouth opening. [23] Ours is probably the first case report where OLV was provided with an Arndt blocker positioned through a nasotracheal tube under fiberoptic bronchoscopy guidance in a patient with both upper and lower airway abnormalities, ie, restricted mouth opening, minimal neck extension, and a distorted tracheobronchial anatomy.…”