Influence of Preoperative One Lung Ventilation in the Lateral Position on Arterial Oxygenation during Subsequent One Lung Ventilation / 대한마취과학회지

BACKGROUND: There are a few reports with conflicting results regarding the potentiation of hypoxic pulmonary vasoconstriction (HPV) by repeated hypoxic challenges. The aim of this study was to determine if preoperative one lung ventilation (OLV) in the lateral position (LP) for a short time decreases the development of arterial hypoxemia and improves the level of arterial oxygenation via the potentiation of HPV in patients undergoing thoracic surgery with OLV. METHODS: Forty patients were randomly divided into two groups according to presence or absence of preoperative OLV. Preoperative OLV in LP was achieved for 10 minutes with 100% O2 in group P (n = 20). Thereafter, the two lungs were again ventilated with 50% O2 until OLV with 100% O2 had been achieved. In group C (n = 20), the two lungs were continuously ventilated with 50% O2 until OLV with 100% O2 was achieved. The arterial blood samples were obtained 15 minutes after the two lung ventilation in the supine position (baseline) during preoperative OLV in LP, before pulmonary vein ligation, as well as before and after pulmonary artery ligation. The development of arterial hypoxemia (peripheral blood oxygen saturation in pulse oximetry < 95%) in patients undergoing thoracic surgery with OLV was also recorded. RESULTS: Arterial hypoxemia during OLV was observed in 2 cases in group C and 3 cases in group P. There was a similar level of arterial oxygen tension during OLV between the two groups. CONCLUSIONS: This study showed that the preoperative OLV in LP for 10 minutes neither potentiated the HPV response during OLV nor decreased the frequency of arterial hypoxemia during OLV.

Comparison of the Effects among Three Methods of Bronchial Blockade in One Lung Ventilation / 대한마취과학회지

BACKGROUND: This study compared the modified BronchoCath double-lumen endotracheal tube (DLT) with the Univent bronchial blocker and Arndt's wire-guided endobronchial blocker (WEB) to determine whether there were objective advantages of one over the other during anesthesia with one lung ventilation. METHODS: Forty five patients having either thoracic or esophageal procedures were randomly assigned to one of three groups. Fifteen patients received a left-side DLT, 15 patients received a Univent tube, and 15 patients received a WEB. The following were studied: 1) time required to position each tube until satisfactory placement was achieved, 2) time required until lung collapse, 3) frequency of malpositions after initial placement with fiberoptic bronchoscopy, 4)surgical exposure ranked by surgeons blinded to type of tube used. RESULTS: Statistically significant differences were observed in time required to place the tube or blocker between the WEB (263.6 +/- 76.0 s), DLT (146.4 +/- 57.7 s, I < 0.0001) and Univent tubes (193.8 +/- 72.4 s, P = 0.0130). There were no significant differences in time to lung collapse, the frequency of malposition or surgical exposure. CONCLUSIONS: We conclude that the DLT, Univent tube, and WEB are useful for one lung anesthesia but it takes longer for the WEB to be placed safely than to place a DLT or Univent tube. The selection between the three tubes depends on type of surgery, difficulty of intubation, and familiarity of each tube by the anesthesiologist.

Clinical Evaluation of One Lung Ventilation during General Anesthesia / 대한구급학회지

BACKGROUND: Separation of two lungs during anesthesia is necessary for the purpose of isolation of one lung from the other to prevent spillage or contamination and facilitating surgical exposure by collapsing the lung in the operative hemithorax. Several techniques are available for providing one-lung anesthesia. This study was performed to evaluate which technique is favored and why it is favored for one-lung ventilation. METHODS: We studied 70 patients scheduled for thoracic surgery aided by collapse of the ipsilateral lung. We analyzed frequency of each technique, efficacy of lung collapse, adequacy of one-lung ventilation, blood gases and complications. RESULTS: In the 63 patients out of 70 patients, the double-lumen tubes were used. Left-sided were used in 57 patients and right-sided were used in 6 patients. There were 3 complications: tracheal rupture, right bronchial rupture and post-operative edema of vocal cords. Bronchial blockers were inserted in 7 patients. It was failed in two cases. Ventilation and oxygenation were respectively good in all patients. CONCLUSIONS: We favored the double-lumen endotrachial tube than Univent blocker. Malposition was frequently seen with the Univent and serious complication was occasionally seen with the double-lumen tube. However surgical exposure and oxygenation was provided with any method, when position was corrected adequately.

Comparison of a Double Lumen Endobronchial Tube with a Single Lumen Tube with Bronchial Blocker for One Lung Anesthesia / 대한마취과학회지

BACKGROUND: Double lumen endobronchial tube and single lumen tube with bronchial blocker are most frequently used tubes for one lung anesthesia. This study compared the double lumen endobronchial tube with the single lumen tube with bronchial blocker to determine whether there were objective advantages of one over the other during one lung anesthesia. METHODS: Sixty patients were randomly assigned to one of two groups. Thirty patients were intubated with a left-sided double lumen endobronchial tube, and thirty patients were intubated with a single lumen tube with bronchial blocker. Each group was subdivided into two groups with a person intubating (i,e, certified anesthesiologist or resident) to compare the easiness of intubation according to the type of tube. Fiberoptic flexible bronchoscope was used in all patients. The following were studied 1) time required to position each tube until satisfactory placement achieved, 2) frequency of malposition after initial placement with fiberoptic bronchoscopy, 3) surgical exposure ranked by surgeons blinded to type of tube used, 4) easiness of tracheobronchial toilet (TBT). RESULTS: 1) Statistically significant differences were observed in time required to place each tube by resident(double lumen tube 5.73+/- 0.48 min. versus single lumen tube with bronchial blocker 4.18+/-0.70 min (P<0.05) and in easiness of TBT (double lumen tube 18/30 versus single lumen tube with bronchial blocker 27/30) (P<0.05). 2) No differences were observed in time required to position each tube by anesthesiologist, the frequency of malposition and surgical exposure. CONCLUSIONS: Single lumen tube with bronchial blocker is better in easiness of intubation by resident and in easiness of TBT than double lumen endobronchial tube. But the selection of two tubes depends upon type of surgery and familiarity of each tube by the anesthesiologist.

Bronchial Cuff Inflation Technique for Proper Positioning of Double-lumen Endobronchial Tube / 대한마취과학회지

BACKGROUND: Accurate placement of double-lumen endobronchial tube(DLT) is essential for successful one-lung anesthesia. This study was performed to evaluate the effectiveness of bronchial cuff inflation technique for accurate placement of DLT. METHODS: One hundred and five patients undergoing elective thoracotomy which required the use of DLTs were studied. Following induction of anesthesia, the tip of the left-sided DLT was advanced just past the vocal cords, the stylet in the endobronchial lumen was removed and the tube was rotated 90 degrees counterclockwise. After rotation of DLT, the bronchial cuff was inflated with air(4-6 ml) and the tube was advanced until resistance to further passage was encountered. After deflating of the bronchial cuff, the tube was advanced 2 cm more distally. The fiberoptic bronchoscopy was then introduced into the tracheal lumen of the tube and the tube's position was evaluated. RESULTS: In the 100 patients out of 105 patients, the tube was inserted into the left side bronchus correctly. In the 77 patients(77 %) out of 100 patients, the position of DLTs was evaluated as ideally placed. In the 16 patients(16 %), the tube was evaluated as too deeply inserted into the appropriate bronchus and in the other 7 patients, the tube was too shallow. But only one patient needed repositioning. CONCLUSIONS: Bronchial cuff inflation technique may be useful for accurate placement of DLT for the one-lung anesthesia in the situation without fiberoptic bronchoscope.

Clinical Evaluation of Univent Tube for One Lung Ventilation / 대한마취과학회지

BACKGROUND: Univent tube(endotracheal tube with a movable blocker), introduced by Inoue et al in 1982, has properties to overcome the disadvantages of double lumen endotracheal tube for one lung anesthesia. This study was performed to evaluate the effectiveness of Univent tube for one lung ventilation. METHODS: Univent tube was inserted to the patients for open thoracic surgery and positioned to the side of bronchus under the guidance of fiberoptic bronchoscope that was scheduled to lung collapse. One lung anesthesia was performed with the inflation of cuff of blocker. Each case was anaylzed with respect to ease or difficulty of positioning of blocker, tube displacement, efficacy of lung collapse and adequacy of single lung ventilation. RESULTS: In the 69 patients out of 80 patients, adequate positioning was performed by first trial. In the two patients, insertion of bronchial blocker was failed that resulted in replacement with a double lumen tube. Observed disadvantages were delayed deflation(10 patients) of affected lung and displacement of bronchial cuff into the main tracheal lumen during position change or surgical manipulation(7 patients). CONCLUSIONS: Univent tube is useful for one lung anesthesia but there are several distinct limitaitons in the safe use.

Movement of Double - lumen Endobronchial Tubes During Position Change / 대한마취과학회지

Accurate placernent of double-lumen endobronchial tube is essential for successful one lung anesthesia We studied 58 adult patients (38 males and 20 females) undergoing thoracic surgery under one lung anesthesia. We used the fiberoptic bronchoscope as an "introducer" over which the double lumen tube was advanced under direct vision. Correct position of the left side double-lumen endobronchial tube at supine position was determined by direct vision of cephalad surface of the bright blue bronchial cuff immediately below the carina. Correct position of the right side double lumen endobronchial tube at supine position was determined by direct vision of the right upper lobe bronchial orifice through the right upper labe ventilation slot. After the patient was repositioned, the position of the double lumen endobronchial tube was rechecked by fiberoptic bronchoscope. The results were as follows; 1) There was a significant correlation of correct depth of left and right double lumen endobronchial tube at supine position with height for both male and female patients. 2) Left side double lumen endobronchial tube: 58% of total cases (20 Case of 38 Case) were displaced by turning of the patient from supine to the lateral decubitus position. 3) Right side double lumen endobronchial tube: 65% of total cases (13 Case of 20 Case) were displaced by turning of the patient from supine to the lateral decubitus position.

The Comparative Study of the Single-lumen Tube and Double-lumen Tube in the Blood Gas Analysis for One-lung Ventilation / 대한마취과학회지

One-lung anesthesia can be very helpful to the surgeon during operations on the lung, mediastinum, esophagus, and thoracic aorta The standard method for one-lung anesthesia uses a double-lumen tube (Carlens, Robertshaw, etc). However, these tubes are diffieult to place and may not remain in a correct position. In addition, the lumen of each channel is inevitably too smaU for proper ventilation and suctioning. We have designed a new device for one-lung anesthesia which overcomes these disadvantages. This new device, named SLT (single-lumen tube), was made by amoured wire tube, the proximal end of which was connected to the Rusch rubber tube. So, this tube is larger in diameter, available in various sizes and very economic. We intubated 25 cardiothoracic patients with SLT under the fiberoptic guidance (Group A), and the other 25 cardiothoracic patients were intubated with Bobertshaw double-lumen tube by the direct laryngoscopy (Group B). There were no significant differences in heart rate, blood pressure, PH, PaCO2, PaO2 BE, HCO3, SaO2 and ETCO2 between the two groups compared with induction, one-lung ventilation, and two-lung ventilation values.

Anesthesia for Transthoracic Endoscopic Sympathectomy / 대한마취과학회지

Technological advances in video camera, high resolution monitors and optical systems have produced considerable process in endoscopic surgery. Recently we have experienced transthoracic endoscopic sympathectomy(TES) for the treatment of Buerger's disease of both hands in a 47 years old male healthy patient. For the TES, one lung ventilation is necessary to provide adequate surgical access, so this patient had general anesthesia with a disposable left sided Robertshaw double lumen endobronchial tube. The patient was monitored for arterial pressure, herat rate, ECG, pulse oximetry, end-tidal carbon dioxide concentration, peak inspired airway pressure and arterial blood gas analysis. Potenial intraoperative problems wese hypoxemia during one-lung anesthesia, hypotension and hypercarbia occurred by insufflation of carbon dioxide into the chest cavity. Our patient also developed moderate hypoxemia which was corrected by application of high frequency jet ventilation with low driving pressure during right sided operation, and increased significantly arterial carbon dioxide tension about 8-12 mmHg during one lung ansthesia. We reviewed our experience and discussed the anesthetic technique and perioperative problems encounterd in the patient undergoing transthoracic endoscopic sympathectomy for Buerger's disease.

One - Lung Anesthesia Using Unient Tube - 2 Cases Report / 대한마취과학회지

We have experienced two cases of one lung anesthesia using univent tube for thoracie surgery. One was the bronchoplasty of the right upper lobe. The other was the left pneumonectomy. The movable endobronchial blocker was introduced into the aimed main bronchus applying the "tube rotation method", In the case of brochoplasty, arterial hypoxemia and hypercarbia has not been corrected well because of the partial obstruction of the carina by endobronchial blocker, but the neurologic complications due to these problems were not encountered. No significant problem has been encountered in the pneumonectomy case. Compared with the standard technique using a double lumen endobronchial tube, this method is simple, easy, effective and less traumatous.

One - Lung Anesthesia of bronchoplasty using Fogarty Catheter / 대한마취과학회지

A method for one-lung anesthesia has been developed in which Fogarty occiusion catheter is used to produce endobronchial blockade. It eliminates most of the problems which occur with the standard technique using a doublelumen cuffed endobronchial tube. No significant problem has been endobronchial tube. No significant problem has been encountered in this bronchoplasty case. This method is so simple and effective. A standard endotracheal tube was introduced, and a Fogarty catheter was inserted through the endotracheal tube to the desired main bronchus just before the left abnormal bronchus was open. After opening the bronchus, the Fogarty catheter could be placed in the appropriate location by sight. Once one-lung ventilation was no longer necessary, the Fogarty catheter could be deflated without distrubing the endotracheal tube.