Comparison of a Silicon Double-Lumen Endobronchial Tube (Silbroncho(R)) with a Polyvinyl Chloride Tube (Broncho-Cath(R)) in Right-Side Thoracic Surgery / 대한마취과학회지

BACKGROUND: Double-lumen endobronchial tube (DLT) malposition and displacement can occur easily by blind intubation or moving a patient into the lateral position. We compared a silicon DLT (Silbroncho(R)) with a polyvinyl chloride tube (Broncho-Cath(R)) to determine whether Silbroncho(R) can reduce the incidence of DLT malposition and displacement during anesthesia for one lung ventilation in right-side thoracic surgery. METHODS: Thirty nine patients requiring right lung deflation were randomly assigned to one of two groups. Eighteen patients received a Broncho-Cath(R) DLT and 21 patients received a Silbroncho(R) in the left mainstem bronchus. After blind intubation, we checked the incidence of right DLT intubation and tracheobronchial injury by fiberoptic bronchoscopy (FOB). After correcting DLTs for exact position and moving patients into the lateral position, we assessed the incidence of DLT displacement and changes of peak inspiratory pressure according to this position change during one lung ventilation. RESULTS: The incidence of right DLT intubation and tracheobronchial injury were not significantly different (P > 0.05) in the two groups (16.7% vs 0%, 38.9% vs 14.3%, Broncho-Cath(R) vs Silbroncho(R), respectively). After position change, the incidence of DLT displacement in the Silbroncho(R) group (4.8%) was lower (P 0.05). CONCLUSIONS: Our results suggest that Silbroncho(R) can reduce the incidence of DLT displacement because of the small-sized bronchial cuff, which is located more distally than the Broncho-Cath(R) cuff. We conclude that Silbroncho(R) is superior to Broncho- Cath(R) for one lung ventilation during thoracic surgery.

Paroxysmal Supraventricular Tachycardia Treated with Esmolol before Anesthesia Induction: A case report / 대한마취과학회지

We describe the case of a 61-year-old woman who manifested with paroxysmal supraventricular tachycardia (PSVT). She was scheduled with gastrectomy and partial hepatectomy because of stomach cancer metastasis. EKG findings were normal in the preoperative period but she had symptoms of palpitation, restlessness, and a high systolic blood pressure (180 mmHg) in the operating room before anesthesia induction. On her EKGs, we recognized a PSVT characterized by a high pulse rate of 180 beats per minute, a narrow QRS complex of 40 msec, and no P wave. These findings were not terminated by carotid massage or antiarrhythmics (verapamil and lidocaine), but were completely treated by the beta-blocker, esmolol. We consider that esmolol is a good choice for the treatment of PSVT with a narrow QRS complex combined with a high blood pressure in case with known hypertension or that have experienced preoperative anxiety or stress.