One-Lung Anesthesia Update

Abstract

One-lung ventilation is used during a variety of cardiac, thoracic, and major vascular procedures. Endobronchial tubes, bronchial blockers, and occasionally, single-lumen tubes are used to isolate the lungs. Patients with difficult airways and pediatric patients provide special challenges for lung isolation. Finally, intraoperative hypoxia and hypercarbia in patients with intrinsic lung disease frequently complicate one-lung anesthesia. The concepts and controversies in lung isolation techniques are discussed.

Single-port thoracoscopic surgery for pneumothorax under two-lung ventilation with carbon dioxide insufflation

“…Our consecutive 130 cases of single-port VATS for primary spontaneous pneumothorax utilized a SILS port under TLVA with low tidal volume and CO 2 gas infusion into the thoracic cavity. OLVA may be indicated in most thoracoscopic surgeries for better visualization of the surgical field after proper collapse of the lung (17). However, OLVA requires a double endotracheal tube or a Univent with a blocker, which is costly compared with a single lumen endotracheal tube (23).…”

“…Despite recent improvements in surgical technique, one-lung ventilation anesthesia (OLVA) is still indicated in most thoracic surgeries and can be performed with double-lumen endotracheal intubation or with bronchial blockers through single lumen endotracheal intubation (17). During VATS for pneumothorax, OLVA is used for the identification and resection of bullous lesions in a non-ventilated state since bullae are most commonly treated with endoscopic stapling.…”

Traumatic tracheal diverticulum corrected with resection and anastomosis during one‐lung ventilation and total intravenous anesthesia in a cat

“…None have described OLV with intermittent periods of total intravenous anesthesia. OLV is well described and often used in human anesthesia . It can be used to isolate a lung or to facilitate ventilatory management in patients undergoing thoracic, mediastinal, vascular, or esophageal procedures.…”

Pressure-Controlled versus Volume-Controlled One-Lung Ventilation for MIDCAB

“…In conclusion, pressure-controlled ventilation improves alveolar gas exchange and augments the recruitment of slower alveolar regions during MIDCAB procedures with OLV and should be a general strategy for OLV management [2,14,15].…”