Atemwegsmanagement in der Thoraxanästhesie mit dem Bronchusblocker

Abstract

Traditionally the double-lumen-tube (DLT) is considered the gold standard for lung separation. Despite being equally feasible for standard situations, there are special populations and circumstances requiring the use of a bronchial blocker (BB) to establish one-lung ventilation. Children under 8 years of age and patients without a patent orotracheal airway necessitate the use of a bronchial blocker in most cases, as well as those requiring selective lobar blockade or a rapid sequence induction. Surgery with predicted postoperative mechanical ventilation or in tracheotomized patients at least favors their use by avoiding the complications of a tube exchange. Bronchial blocker models currently in clinical use include the wire-guided Arndt-Blocker, the Flexitip Cohen-Blocker, the Fuji Uniblocker, the Y-shaped EZ-Blocker and the tracheoscopy-guided VivaSight-EB. Their common concept is the occlusion of the operative lung by the inflation of their distal balloon, with the deflation of that lung occurring through their inner lumen. They mainly differ in their mode of placement. Bronchial blockers offer a clinical performance comparable to the DLT. Placement times for lung isolation devices and surgical exposure may depend more on the experience of the anaesthetist than the device itself. Bronchial blockers won't replace the DLT as gold standard at least due to their cost of acquisition, but provided adequate training outside of the emergency situation, their utilisation offers equal operative conditions at comparable placement times, dislocation rates and ease of use. A modern bronchial blocker should be available in institutions managing complex thoracic cases.

Anästhesie bei einer thoraxchirurgischen Patientin mit kongenitaler Muskeldystrophie Typ Ullrich

“…Zum Management des schwierigen Atemwegs bei thoraxchirurgischen Patienten sei auf einschlägige Übersichtsarbeiten verwiesen [ 17 , 18 ]. Im vorliegenden Fall schlossen die anatomischen Verhältnisse die Platzierung eines Doppellumentubus aus, und die Einlungenventilation konnte komplikationslos mittels Bronchusblocker vorgenommen werden [ 19 ].…”