One-Lung Ventilation for Surgical Repair of Thoracic Aortic Aneurysm

Abstract

Advances in the surgical approach to thoracic aortic aneurysm repairs have led to the increasing use of one-lung ventilation. Today's practice of cardiothoracic and vascular anesthesia requires a clear understanding of the techniques available for lung separation and the technical skills necessary to employ them. In this article, we discuss and evaluate the options for one-lung ventilation in thoracic aortic aneurysm repair with regard to preoperative, intraoperative, and postoperative management.

The anaesthetic management of patients with thoracic ascending aortic aneurysms: A review

“…An artistic rendering of an aortic aneurysm located superior to the left mainstem bronchus as well as a computed tomography scan of the same (Goodwin et al 2013)…”

“…The use of fibreoptic bronchoscopy is essential. Lung protective ventilation including low tidal volume, low peak airway pressures, high positive end-expiratory pressure (PEEP), and a lower fraction of inspired oxygen (FiO 2 ) is an important aspect of anaesthetic management (Campos 2007, Cohen 2001, Goodwin et al 2013, Weigel & Hoaglan 2013).…”

Cinching the loop on the Arndt endobronchial blocker during placement for descending aortic aneurysm surgery

“…This may result in narrowing the bronchial lumen and increasing the risk of a ruptured aneurysm due to direct trauma from the DL-ETT to the thinned out bronchial wall. 2 Although a right-sided DL-ETT is an alternative, it has its own difficulties with correct placement. 3 Another disadvantage of a DL-ETT is that it needs to be replaced by a single-lumen ETT at the end of generally very prolonged surgery.…”

Marfan Syndrome

“…Preoperative examination of the airway is critical because the presence of prognathism and a high palate may pose difficulties during tracheal intubation. 46 Finally, complete examination of the joints and evaluation of their laxity are important to avoid dislocations and injuries when positioning the patient on the operating table. This will also be applicable during intubation where excessive traction of the temporomandibular joint should be avoided.…”

“…Before endotracheal intubation, a fiber-optic bronchoscope is used for inspection of the airway to avoid compression of the aneurysm. 46 Tracheal intubation can be facilitated with the use of succinylcholine or a short-acting nondepolarizing agent. To blunt the hemodynamic response elicited by tracheal intubation, we recommend the generous administration of fentanyl during induction (15-25 µg/kg).…”