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Anesthesia for thoracoscopic surgery.

Conacher ID - J Minim Access Surg (2007)

Bottom Line: Lung separators in the airway are essential tools.Analgesia management is modelled on that shown effective and therapeutic for thoracotomy.Perioperative management needs to reflect the concern for these complex, and complicating, processes to the morbidity of thoracoscopic surgery.

View Article: PubMed Central - PubMed

Affiliation: Department of Thoracic Anesthesia, Freeman Hospital, Newcastle Upon Tyne Nhs Hospital Trust, Freeman Road, Newcastle Upon Tyne, NE7 7DN, England.

ABSTRACT
Anesthesia for thoracoscopy is based on one lung ventilation. Lung separators in the airway are essential tools. An anatomical shunt as a result of the continued perfusion of a non-ventilated lung is the principal intraoperative concern. The combination of equipment, technique and process increase risks of hypoxia and dynamic hyperinflation, in turn, potential factors in the development of an unusual form of pulmonary edema. Analgesia management is modelled on that shown effective and therapeutic for thoracotomy. Perioperative management needs to reflect the concern for these complex, and complicating, processes to the morbidity of thoracoscopic surgery.

No MeSH data available.


Related in: MedlinePlus

Lung separators. (from L to R) Double lumen tube (right sided - note slot for upper lobe bronchus): Endobronchial tube (Macintosh Leatherdale - left sided): Bronchus blocker (Cohen/Cook model) and ancillary
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Figure 0001: Lung separators. (from L to R) Double lumen tube (right sided - note slot for upper lobe bronchus): Endobronchial tube (Macintosh Leatherdale - left sided): Bronchus blocker (Cohen/Cook model) and ancillary

Mentions: Lung separators are inserted into the airway and stabilized in one or other bronchus. There are three categories of lung separator: the double-lumen tube, the bronchus blocker and, increasingly difficult to acquire, the endobronchial tube [Figure 1]. For each, there are positives and negatives, which are beyond the brief here. Given the trends in materials and technology and an increasing reliance of the anesthetic corpus on fibreoptic devices to help secure the airway, there is little doubt that the new generation bronchus blockers such as the Univent, Arndt or Cohen cater to perceived modern needs.[6] Logic, that older generation devices (transferable and perfectly adequate) as in many medical consumerist situations, is stifled by the weaknesses for imperatives of commerce and fashion. Modern systems are dependent for safe operation on fibreoptic technology: something of a case of a necessity becoming a virtue. For those resistant to these compelling ideas, it is worth remembering that the double lumen tube is simple, flexible and best sited with endobronchial portion in the left main bronchus.[7] This gives reliably better lung separating conditions and easier change for bilateral and sequential procedures such as sympathectomy or the different phases of an oesophagectomy.[8] It has been noted that the bronchus blockers may not give adequate support to the bronchus of the lung being ventilated with a significant increase in risk of producing air-trapping, circulatory dysfunction and barotraumas.[9] This may be increasingly pertinent with the rise in numbers of the obese in developed societies presenting for surgery. And is just one of several potential causes of a dangerous and confusing clinical complex of dynamic hyperinflation. This may require urgent treatment and a remedial pattern of positive pressure ventilation. The presenting syndromic of hypoxia and hypotension however is much more a common feature when there is intrinisic pulmonary pathology; and is particularly marked in thoracoscopic lung volume reduction surgery.[1011]


Anesthesia for thoracoscopic surgery.

Conacher ID - J Minim Access Surg (2007)

Lung separators. (from L to R) Double lumen tube (right sided - note slot for upper lobe bronchus): Endobronchial tube (Macintosh Leatherdale - left sided): Bronchus blocker (Cohen/Cook model) and ancillary
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2749195&req=5

Figure 0001: Lung separators. (from L to R) Double lumen tube (right sided - note slot for upper lobe bronchus): Endobronchial tube (Macintosh Leatherdale - left sided): Bronchus blocker (Cohen/Cook model) and ancillary
Mentions: Lung separators are inserted into the airway and stabilized in one or other bronchus. There are three categories of lung separator: the double-lumen tube, the bronchus blocker and, increasingly difficult to acquire, the endobronchial tube [Figure 1]. For each, there are positives and negatives, which are beyond the brief here. Given the trends in materials and technology and an increasing reliance of the anesthetic corpus on fibreoptic devices to help secure the airway, there is little doubt that the new generation bronchus blockers such as the Univent, Arndt or Cohen cater to perceived modern needs.[6] Logic, that older generation devices (transferable and perfectly adequate) as in many medical consumerist situations, is stifled by the weaknesses for imperatives of commerce and fashion. Modern systems are dependent for safe operation on fibreoptic technology: something of a case of a necessity becoming a virtue. For those resistant to these compelling ideas, it is worth remembering that the double lumen tube is simple, flexible and best sited with endobronchial portion in the left main bronchus.[7] This gives reliably better lung separating conditions and easier change for bilateral and sequential procedures such as sympathectomy or the different phases of an oesophagectomy.[8] It has been noted that the bronchus blockers may not give adequate support to the bronchus of the lung being ventilated with a significant increase in risk of producing air-trapping, circulatory dysfunction and barotraumas.[9] This may be increasingly pertinent with the rise in numbers of the obese in developed societies presenting for surgery. And is just one of several potential causes of a dangerous and confusing clinical complex of dynamic hyperinflation. This may require urgent treatment and a remedial pattern of positive pressure ventilation. The presenting syndromic of hypoxia and hypotension however is much more a common feature when there is intrinisic pulmonary pathology; and is particularly marked in thoracoscopic lung volume reduction surgery.[1011]

Bottom Line: Lung separators in the airway are essential tools.Analgesia management is modelled on that shown effective and therapeutic for thoracotomy.Perioperative management needs to reflect the concern for these complex, and complicating, processes to the morbidity of thoracoscopic surgery.

View Article: PubMed Central - PubMed

Affiliation: Department of Thoracic Anesthesia, Freeman Hospital, Newcastle Upon Tyne Nhs Hospital Trust, Freeman Road, Newcastle Upon Tyne, NE7 7DN, England.

ABSTRACT
Anesthesia for thoracoscopy is based on one lung ventilation. Lung separators in the airway are essential tools. An anatomical shunt as a result of the continued perfusion of a non-ventilated lung is the principal intraoperative concern. The combination of equipment, technique and process increase risks of hypoxia and dynamic hyperinflation, in turn, potential factors in the development of an unusual form of pulmonary edema. Analgesia management is modelled on that shown effective and therapeutic for thoracotomy. Perioperative management needs to reflect the concern for these complex, and complicating, processes to the morbidity of thoracoscopic surgery.

No MeSH data available.


Related in: MedlinePlus