Jane.y.xu.med: Reformatted

2023-07-14T01:50:37Z

Reformatted

New page

{{Infobox surgical procedure
| anesthesia_type = Thoracic Surgery
| airway =
| lines_access =
| monitors =
| considerations_preoperative =
| considerations_intraoperative =Displacement
Airway injury/obstruction
Interference with staple line
| considerations_postoperative =
}}

'''<big>Definition:</big>''' <big>High-pressure low-volume balloon device utilized for complete one-lung isolation or selective lobar blockade</big>

==Types==

*Wire-guided bronchial blocker
*Tip-deflecting bronchial blocker
*Double-cuffed bronchial blocker with bifurcated end
*Bronchial blocker with attached stylet

==Specific Indications==

*Present contraindications for double-lumen endotracheal tube (DLT)<ref name=":0">{{Cite journal|last=Cohen|first=Edmond|date=2021-08-23|title=Current Practice Issues in Thoracic Anesthesia|url=http://dx.doi.org/10.1213/ane.0000000000005707|journal=Anesthesia & Analgesia|volume=Publish Ahead of Print|doi=10.1213/ane.0000000000005707|issn=0003-2999}}</ref>,<ref>{{Cite journal|last=Campos|first=Javier H|date=2010-02|title=Lung isolation techniques for patients with difficult airway|url=http://dx.doi.org/10.1097/aco.0b013e328331e8a7|journal=Current Opinion in Anaesthesiology|volume=23|issue=1|pages=12–17|doi=10.1097/aco.0b013e328331e8a7|issn=0952-7907}}</ref>:
**Anticipated difficult airway, including present airway trauma
**Abnormal tracheal anatomy (tracheal stenosis, etc)
**Airway distortion
*High likelihood of post-operative mechanical ventilation<ref name=":1">{{Cite journal|last=Kosarek|first=L|date=2013|title=Effective use of bronchial blockers in lung isolation surgery: an analysis of 130 cases|journal=Ochsner|volume=13|pages=389-393}}</ref>
*Presence of pre-existing tracheostomy, nasotracheal tube, single-lumen endotracheal tube (SLT)<ref name=":1" />
*Restricted mobility (scoliosis, prior radiation)<ref name=":0" />
*Selective lobar blockade<ref name=":0" />
*Pediatric patients who cannot tolerate DLT

==Contraindications<ref name=":2">{{Citation|last=Campos|first=Javier|title=Anesthesia for Robotic Thoracic Surgery|date=2011|url=http://dx.doi.org/10.1007/978-1-4419-0184-2_31|work=Principles and Practice of Anesthesia for Thoracic Surgery|pages=445–451|place=New York, NY|publisher=Springer New York|isbn=978-1-4419-0183-5|access-date=2023-07-14}}</ref><ref name=":3">{{Cite journal|last=Clayton-Smith|first=Ana|last2=Bennett|first2=Kyle|last3=Alston|first3=Robin Peter|last4=Adams|first4=George|last5=Brown|first5=Greg|last6=Hawthorne|first6=Timothy|last7=Hu|first7=May|last8=Sinclair|first8=Angus|last9=Tan|first9=Jay|date=2015-08|title=A Comparison of the Efficacy and Adverse Effects of Double-Lumen Endobronchial Tubes and Bronchial Blockers in Thoracic Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Trials|url=http://dx.doi.org/10.1053/j.jvca.2014.11.017|journal=Journal of Cardiothoracic and Vascular Anesthesia|volume=29|issue=4|pages=955–966|doi=10.1053/j.jvca.2014.11.017|issn=1053-0770}}</ref>==

*Bilateral thoracic procedures (double-lung transplant)
*Tumors blocking main bronchus, especially right-sided

==Operating Room Setup==

*Preferred bronchial blocker device
**Adult sizing: 7 French vs. 9 French
**Pediatric sizing: 5 French
*SLT > 7.5 cm internal diameter
*Fiberoptic bronchoscope (ensure correct positioning of blocker) < 4.0 mm outer diameter

==Placement<ref name=":2" />==

*Specific placement technique is dependent on device type
*Before insertion, test integrity of cuff and fully deflate and lubricate blocker
*General instructions:
**Intubate the patient using SLT>7.5 cm
**Advance fiberoptic bronchoscope through SLT to the level of the carina
**Advance bronchial blocker to the same level and direct blocker into right or left mainstem bronchus using clockwise and counterclockwise twisting motion, respectively
**Place bronchial blocker balloon 5-10 mm below carina for one-lung ventilation under guidance of bronchoscopy
**Stop PPV to allow complete expiration and deflation of lung
**Inflate cuff with air (generally 4-8 mL) to secure position and isolate lung
**Remove fiberoptic bronchoscope after ensuring correct position
**Syringe can be attached to end of bronchial blocker to further suction out air and deflate lung
*Repositioning of patient requires deflation and re-inflation of balloon to avoid displacement and airway obstruction – reconfirm placement with bronchoscopy
*Additional materials that may be available depending on device:
**Specialized multi-port adaptor with outlets for bronchoscope, blocker, ETT tube (ventilating possible), and airway circuit
**Specialized SLT with extra lumen specific for bronchial blocker placement

==Advantages<ref name=":3" /><ref name=":4">{{Citation|last=Brodsky|first=Jay B.|title=Lung Separation|date=2020-12-03|url=http://dx.doi.org/10.1017/9781108303477.029|work=Core Topics in Airway Management|pages=243–249|publisher=Cambridge University Press|access-date=2023-07-14}}</ref>==

*Available use for any type of secured airway (oral, nasal, tracheostomy)
*No need for tube exchange
*Lower potential for serious airway trauma (airway rupture, etc)

==Disadvantages==

*Compared to DLT:
**Higher rate of displacement<ref name=":5">{{Cite journal|last=Narayanaswamy|first=M.|date=April 2009|title=Choosing a lung isolation device for thoracic surgery: a randomized trial of three bronchial blockers versus double-lumen tubes|url=doi: 10.1213/ane.0b013e3181999339|journal=Anesth Analg.|volume=108(4)|pages=1097-1101}}</ref>
**More prone to repositioning, especially when right-sided blockade is needed<ref name=":4" />
**Limited suctioning capability due to narrower lumen
**More expensive
*Requires placement of SLT > 7.5 mm inner diameter
*Limits size of fiberoptic bronchoscope

==Reported Complications<ref name=":1" /><ref name=":3" /><ref name=":2" /><ref name=":4" /><ref name=":5" />==

*Airway injury (including bronchial rupture)
*Interference with staple line during pulmonary resection, especially during right middle lobe and lower lobectomy
*Complete airway obstruction due to displacement into trachea

==References==
1. Cohen, Edmond MD, FASA. Current Practice Issues in Thoracic Anesthesia. Anesthesia & Analgesia 133(6):p 1520-1531, December 2021. | DOI: 10.1213/ANE.0000000000005707

2. Campos JH. Lung isolation techniques for patients with difficult airway. Curr Opin Anaesthesiol. 2010 Feb;23(1):12-7. doi: 10.1097/ACO.0b013e328331e8a7. PMID: 19752725.

3. Kosarek L, Busch E, Abbas A, Falterman J, Nossaman BD. Effective use of bronchial blockers in lung isolation surgery: an analysis of 130 cases. Ochsner J. 2013 Fall;13(3):389-93. PMID: 24052770; PMCID: PMC3776516.

4. Campos J. Lung isolation. In: Slinger P (ed). Principles and Practice of Anesthesia for Thoracic Surgery. 2nd edition. Switzerland. Springer Nature. 2019: 283-309.

5. Clayton-Smith A, Bennett K, Alston RP, Adams G, Brown G, Hawthorne T, Hu M, Sinclair A, Tan J. A Comparison of the Efficacy and Adverse Effects of Double-Lumen Endobronchial Tubes and Bronchial Blockers in Thoracic Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Trials. J Cardiothorac Vasc Anesth. 2015 Aug;29(4):955-66. doi: 10.1053/j.jvca.2014.11.017. Epub 2014 Dec 2. PMID: 25753765.

6. Brodsky, J. (2020). Lung Separation. In T. Cook & M. Kristensen (Eds.), Core Topics in Airway Management (pp. 243-249). Cambridge: Cambridge University Press. doi:10.1017/9781108303477.029

7. Narayanaswamy M, McRae K, Slinger P, Dugas G, Kanellakos GW, Roscoe A, Lacroix M. Choosing a lung isolation device for thoracic surgery: a randomized trial of three bronchial blockers versus double-lumen tubes. Anesth Analg. 2009 Apr;108(4):1097-101. doi: 10.1213/ane.0b013e3181999339. PMID: 19299767.
[[Category:Surgical procedures]]
[[Category:Thoracic Surgery]]

Bronchial blocker - Revision history

Jane.y.xu.med: Reformatted