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Use of two Endotracheal Tubes to Perform Lung Isolation and One-Lung Ventilation in a Patient With Tracheostomy Stenosis: A Case Report.

Taghavi Gilani M, Fathi M, Razavi M - Anesth Pain Med (2014)

Bottom Line: Since the patient had tracheostmy stomal stenosis, two cuffed tracheal tubes (internal diameter = 4.5 mm) were used; one tube was placed in the right bronchus and the other tube in the left one by fiberoptic laryngoscopy in 10 minutes.Potential trauma from a double-lumen tube and a bronchial blocker as well as inaccessibility to a univent tube prevented us to use these standard methods in this case.This report presents a new method for lung isolation in specific cases and in the absence of certain equipment.

View Article: PubMed Central - PubMed

Affiliation: Cardiac Anesthesia Research Center, Imam-Reza Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

ABSTRACT

Introduction: Lung isolation is a common technique used in thoracic surgery to prevent spillage to unaffected lung and to provide a better view for the surgeon.

Case presentation: A 41-year-old woman with a history of pharyngo-laryngo-oesophagectomy (PLO) and tracheostomy was a candidate for thoracic duct ligation because of chylothorax. Since the patient had tracheostmy stomal stenosis, two cuffed tracheal tubes (internal diameter = 4.5 mm) were used; one tube was placed in the right bronchus and the other tube in the left one by fiberoptic laryngoscopy in 10 minutes. Right lung was collapsed during the surgery for 3.5 hours with a slight decrease in oxygenation (SpO2 = 91%-93%) and with no evident hemodynamic change. Potential trauma from a double-lumen tube and a bronchial blocker as well as inaccessibility to a univent tube prevented us to use these standard methods in this case.

Conclusions: This report presents a new method for lung isolation in specific cases and in the absence of certain equipment.

No MeSH data available.


Related in: MedlinePlus

Double Endotracheal Tube after Intubation
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fig13347: Double Endotracheal Tube after Intubation

Mentions: After the patient was anesthetized, a cuffed tracheal tube number 4.5 (internal diameter of 4.5 mm and external diameter of 6.2 mm) was inserted from a narrow tracheostomy tube and fixed in the trachea. The cuff was filled, then 20 mg atracurium was injected, and the patient was ventilated manually. Next, the cuff deflated and by a narrow child-sized fiberoptic bronchoscope, the tracheal tube was directed to the right bronchus. After pulmonary ventilation of the right lung was confirmed, another 4.5 cuffed tube was slowly inserted through the tracheostomy; this caused minor trauma and mild bleeding. Then the tube was directed to the left bronchus, the cuff was inflated, and ventilation of the left lung was verified. Both lungs were ventilated via a Y-piece connection (Figure 2), and a leak test was applied to ensure that no air leaked out of the lungs.


Use of two Endotracheal Tubes to Perform Lung Isolation and One-Lung Ventilation in a Patient With Tracheostomy Stenosis: A Case Report.

Taghavi Gilani M, Fathi M, Razavi M - Anesth Pain Med (2014)

Double Endotracheal Tube after Intubation
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4286801&req=5

fig13347: Double Endotracheal Tube after Intubation
Mentions: After the patient was anesthetized, a cuffed tracheal tube number 4.5 (internal diameter of 4.5 mm and external diameter of 6.2 mm) was inserted from a narrow tracheostomy tube and fixed in the trachea. The cuff was filled, then 20 mg atracurium was injected, and the patient was ventilated manually. Next, the cuff deflated and by a narrow child-sized fiberoptic bronchoscope, the tracheal tube was directed to the right bronchus. After pulmonary ventilation of the right lung was confirmed, another 4.5 cuffed tube was slowly inserted through the tracheostomy; this caused minor trauma and mild bleeding. Then the tube was directed to the left bronchus, the cuff was inflated, and ventilation of the left lung was verified. Both lungs were ventilated via a Y-piece connection (Figure 2), and a leak test was applied to ensure that no air leaked out of the lungs.

Bottom Line: Since the patient had tracheostmy stomal stenosis, two cuffed tracheal tubes (internal diameter = 4.5 mm) were used; one tube was placed in the right bronchus and the other tube in the left one by fiberoptic laryngoscopy in 10 minutes.Potential trauma from a double-lumen tube and a bronchial blocker as well as inaccessibility to a univent tube prevented us to use these standard methods in this case.This report presents a new method for lung isolation in specific cases and in the absence of certain equipment.

View Article: PubMed Central - PubMed

Affiliation: Cardiac Anesthesia Research Center, Imam-Reza Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

ABSTRACT

Introduction: Lung isolation is a common technique used in thoracic surgery to prevent spillage to unaffected lung and to provide a better view for the surgeon.

Case presentation: A 41-year-old woman with a history of pharyngo-laryngo-oesophagectomy (PLO) and tracheostomy was a candidate for thoracic duct ligation because of chylothorax. Since the patient had tracheostmy stomal stenosis, two cuffed tracheal tubes (internal diameter = 4.5 mm) were used; one tube was placed in the right bronchus and the other tube in the left one by fiberoptic laryngoscopy in 10 minutes. Right lung was collapsed during the surgery for 3.5 hours with a slight decrease in oxygenation (SpO2 = 91%-93%) and with no evident hemodynamic change. Potential trauma from a double-lumen tube and a bronchial blocker as well as inaccessibility to a univent tube prevented us to use these standard methods in this case.

Conclusions: This report presents a new method for lung isolation in specific cases and in the absence of certain equipment.

No MeSH data available.


Related in: MedlinePlus