High Frequency Jet Ventilation of One Lung using a Bronchial Blocker of Univent during Carinal Resection

Chin, Ji Hyun; Lee, Eun‐Ho; Choi, Dae Ki; Choi, In‐Cheol

doi:10.3346/jkms.2010.25.7.1083

Cited by 12 publications

(12 citation statements)

References 13 publications

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“…Different methods in airway management have been reported concerning tracheal or carinal resection. [ 3 – 6 ] High-frequency jet ventilation, providing an uninterrupted surgical field, may predispose patients to potential risk of trapping or barotraumas during thoracoscopic carinal resection. [ 3 , 5 ] And the procedure would be interrupted by the spray of blood across the operating field.…”

Section: Discussionmentioning

confidence: 99%

“…[ 3 – 6 ] High-frequency jet ventilation, providing an uninterrupted surgical field, may predispose patients to potential risk of trapping or barotraumas during thoracoscopic carinal resection. [ 3 , 5 ] And the procedure would be interrupted by the spray of blood across the operating field. [ 7 ] Cross-field ventilation has also been described in the surgical literatures as being used in complex tracheal surgeries.…”

Section: Discussionmentioning

confidence: 99%

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Use of Univent tube for intermittent lung isolation during thoracoscopic mediastinal tracheal resection and reconstruction

Zhang

Xin²,

Ma³

et al. 2017

Medicine

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Rationale:Primary tracheal adenoid cystic carcinoma of the trachea primary is a rare neoplasm and commonly misdiagnosed. Lung isolation during surgery and ventilation pose a tremendous challenge to anesthesiologists.Patient concerns:The authors describe a novel technique of lung isolation and ventilation with a Univent tube during thoracoscopic mediastinal tracheal resection and reconstruction in a female patient.Diagnoses:Primary tracheal adenoid cystic carcinoma, nonsmall cell carcinoma.Interventions:In this case, tracheal resection and reconstruction were performed. A bronchial blocker of the Univent tube was used as a guide to manipulate the depth of endotracheal tube.Outcomes:The intermittent 1-lung ventilation was established successfully. The patient recovered uneventfully and discharged after 10 days.Lessons:The advantages of approach include a stable airway management without occupying the contracted space of thoracoscope and no potential risk of trapping or barotraumas.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Use of Univent tube for intermittent lung isolation during thoracoscopic mediastinal tracheal resection and reconstruction

Zhang

Xin²,

Ma³

et al. 2017

Medicine

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“…However, DLTs have been used successfully in carinal surgery and some even advocate for use post-operatively to limit PPV on the anastamosis [13]. For the same reasons we avoided a DLT, we felt a bronchial blocker or uninvent tube would not be an option either, though these tubes have been used [14].…”

Section: Discussionmentioning

confidence: 99%

Anesthetic Management of a Delayed Carinal Resection Following Traumatic Disruption

Blackney¹,

Alfille²

2014

OJAnes

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Resecting and reconstructing the carina is an anesthetic challenge in the best of circumstances. The surgery is meticulous and requires access to the trachea and bronchi, ruling out traditional lung isolation techniques. When resection of the carina is due to traumatic disruption, confounding thoracic injuries can make adequate ventilation and oxygenation difficult, especially when only one lung is available for ventilation. ECMO is an intervention that provides sufficient oxygenation and an unimpeded surgical field. ECMO also allows use of smaller airway management tools that can be used to ventilate the dependent lung, thus preventing atelectasis and producing better postoperative outcomes.

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“…HFJV via the lumen of the blocker tube, which helped achieve 1-lung ventilation without causing any injury to the tumor, resolved such concerns without causing either hypercapnea or hypoxemia. 2 Carinal reconstruction is associated with several concerns, including a reduction of anastomotic tension and types of the reconstruction and sutures, even in open procedures. 1 The thoracoscopic carinal surgery is more complex.…”

Section: Discussionmentioning

confidence: 99%

Thoracoscopic carinal resection and reconstruction in a patient with mucoepidermoid carcinoma

Nakanishi

Yamashita

Muranaka

et al. 2013

The Journal of Thoracic and Cardiovascular Surgery

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Video clip is available online.Resection of any tumor that involves the carina requires a thoracotomy because of technical difficulties in airway management and carinal reconstruction. 1 This report presents the first known case of thoracoscopic carinal resection and reconstruction in a patient with a carinal tumor. CLINICAL SUMMARYA 39-year-old woman rearing 2 children had hemoptysis. Radiologic images showed a carinal tumor without any other associated diseases ( Figure 1). A transbronchial biopsy revealed carcinoma. Thoracoscopic surgery was planned to allow the patient an early return to her normal life.One-lung ventilation was established using an endobronchial blocker tube. Thoracoscopic carinal surgery was begun while viewing only a video monitor, without rib spreading, through an access window measuring 4.0 cm in length that was placed in the third intercostal space on the anterior axillary line and 2 additional 1.2-cm diameter ports placed in the sixth intercostal spaces on the auscultatory triangle and the midaxillary line. Hilar and mediastinal lymph node dissections were performed after division of the pulmonary ligament. The left main bronchus and the trachea were mobilized by blunt dissection. The traction 4-0 monofilament sutures of both the left bronchus and the trachea were extracted to the outside of the body using the Endo Close device (Tyco Healthcare, Norwalk, Conn) through the third and seventh intercostal spaces on the midaxillary line, respectively. The carina measuring 4.0 cm in length with the involved area was then removed with adequate margins that were pathologically negative for malignancy. Anastomosis between the trachea and the left bronchus was primarily performed in an end-to-end fashion with 3-0 absorbable monofilament sutures after reduction of the tension by drawing the traction sutures. The right main bronchus was then implanted below the first anastomosis in an end-to-side fashion. The anastomoses were FIGURE 1. Computed tomographic scans of the chest showing an abnormal mass approximately 2.6 cm in diameter involving the carina. A, Axial view. B, Coronal view. From the Departments of Thoracic Surgery a and Anesthesiology, b Shin-Kokura Hospital, Federation of National Public Service, Personnel Mutual Aid Associations, Kitakyushu, Japan. Disclosures: Authors have nothing to disclose with regard to commercial support.

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High Frequency Jet Ventilation of One Lung using a Bronchial Blocker of Univent during Carinal Resection

Cited by 12 publications

References 13 publications

Use of Univent tube for intermittent lung isolation during thoracoscopic mediastinal tracheal resection and reconstruction

Use of Univent tube for intermittent lung isolation during thoracoscopic mediastinal tracheal resection and reconstruction

Anesthetic Management of a Delayed Carinal Resection Following Traumatic Disruption

Thoracoscopic carinal resection and reconstruction in a patient with mucoepidermoid carcinoma

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