Methods for Single-Lung Ventilation in Pediatric Patients

Abstract

lobectomy was performed. The infant was sent to the PICU for further care and transferred to a normal baby room 3 days later. The follow-up chest X-ray showed full expansion of the left upper lung lobe without evidence of residual pneumatocele (Figure 2c).When anesthetizing infants with lung lesions, one of the most important questions is whether positive pressure ventilation will cause cardiopulmonary deterioration. For patients with pneumatoceles, spontaneous ventilation and single lung ventilation (SLV) should be considered (2). In the first case, we tried to keep spontaneous respiration before and after intubation and then move the tracheal tube for SLV without muscle relaxants. However, laryngospasm developed after two intubation attempts. In this situation, intermittent positive pressure ventilation could not be avoided to maintain the oxygen saturations and thereafter, tension pneumatoceles expanded with sudden cardiopulmonary collapse. In this case, multiple percutaneous decompressions effectively restored cardiac output.In the second case, we changed the plan of anesthesia. We used a muscle relaxant and applied low pressure ventilation (not higher then 10 cmH 2 O) so tracheal intubation was smooth. Intentional endobronchial intubation was performed and right side SLV was confirmed by auscultation then fiberoptic bronchoscopy. There was no untoward event during induction or surgery. Although a high frequency oscillator and 14G catheters were available for emergency use, they were not used.Single lung ventilation can be achieved with use of a balloon-tipped bronchial blocker, Univent tube or doublelumen tracheal tube in adults or children. However, a double-lumen tube for infants is usually unavailable (3). Pawar and Marraro (4) reported their experience with small-sized double-lumen tracheal tubes, but these tubes are not widely available. In the second case, SLV was achieved with the use of a normal tube. We deviated the tip to the right and gently pushed the tube into the airway until resistance was felt.In conclusion, anesthesia for infants with pneumatoceles remains a challenge with a risk of possible cardio-pulmonary deterioration. Careful planning and successful airway management are keys to successful practice. Chih-M in LiuReferences 1 Imamoglu M, Cay A, Kosucu P, et al. Pneumatoceles in postpneumonic empyema: an algorithmic approach.

Single-lung ventilation in a pediatric patient using a pediatric fibreoptically-directed wire-guided endobronchial blocker

“…blockers or Fogarty catheters, pediatric size Univent® (Vitaid Ltd., Lewiston, NY, USA) endotracheal tube and double-lumen tubes (Marraro pediatric bi-lumen tube). 1 However, each technique is associated with various problems. While selective endobronchial intubation under direct fibreoptic view may appear to be a simple technique requiring only a bronchoscope, there may be difficulty in creating an adequate seal for lung deflation, especially when an uncuffed endotracheal tube is used.…”

Anaesthe Sia for a Paediatric S Patient Posted for Video : Assisted Thoracoscopic Excision of an Anterior Mediastinal Mass

“…3,4 Hence the modes for one lung ventilation has to be carefully chosen keeping in mind not only the availability but also the feasibility of the technique adopted. 5 Today, several methods are available for isolating a single lung and instituting single lung ventilation. This will depend on the type of surgery, the patient, and anesthetist feasibility, surgeon preference.…”

“…The choice of any method depends on specific equipment availability & feasibility of the technique. 5,6,7 Double-lumen endobronchial tube (EBT) can provide numerous advantages in executing successful one lung ventilation DLT allows suctioning, administration of continuous positive-airways (CPAP) or oxygen insufflation to the non-operative lung. But these are unsuitable in patients less than 30 to 35 kg because the smallest, commonly available DLT is size 28F.…”

“…The disadvantages of this include: dislodgement of the blocker balloon into the trachea, slow collapse of the operated lung, high pressure cuff can damage or even rupture the airway, suctioning of the operative lung not feasible. 5,8 The Univent tube is like a conventional ETT with a second lumen containing a small hollow non-latex bronchial blocker that can be extended about 8-10 cm beyond the tip and when the balloon is inflated, it serves as a blocker. It is placed in the same manner as a standard tracheal tube and when one-lung ventilation is required, the bronchial blocker is advanced into the main stem bronchus of the operative lung under direct vision with a flexible fibreoptic bronchoscope.…”

Anesthesia in Pediatric Thoracic Surgery

“…Özellikle adölesanda tüp ölçüsü ve havayolu çapları oldukça değişkenlik göstermektedir. Çocuklarda ortalama değerlere göre hazırlanan ve TAV için önerilen tüp seçimi Tablo 2'de özetlenmiştir (6,25).…”