Clinical application of Disposcope endoscope in Univent tube intubation and positioning / 临床麻醉学杂志

Objective To observe the clinical application effects of Disposcope endoscope in Univent tube intubation and positioning.Methods Eighty patients underwent scheduled thoracic sur gery (51 males,29 females,aged 18-77 years,ASA Ⅰ-Ⅲ) under one-lung ventilation (OLV) were randomly grouped into two groups:Disposcope endoscope group (group D) and laryngoscope group (group L),40 patients in each group.Group D used Disposcope endoscope for intubation and positio ning while group L used laryngoscope for intubation and auscultation positioning.Patients with difficult intubation,severe ventilation dysfunction and large sputum volume,such as pulmonary hemoptysis and bronchiectasis,were excluded.Intubation and positioning time,airway pressure and arterial carbon dioxide partial pressure (PaCO2) were recorded during double-lung ventilation and OLV,lung collapse effect,and one-time successful intubation ratio,positionging adjustment ratio and the incidence of intubation complications were calculated.Results Intubation and positioning time were significantly longer in group L than in group D [(169.98±52.65)s vs.(102.38±44.45)s](P＜0.05),one-time successful intubation ratio in group L was lower than that in group D (80％ vs.97.5％) (P ＜0.05).The difference of airway pressure and PaCO2 during double-lung ventilation and OLV between the two groups were not statistically significant.The blocker positioning adjust ratio of Univent tube in group L was significantly higher than that in group D (22.5％ vs.7.5％)(P＜0.05).The incidence of bleeding and sore throat after operation in group L were significantly higher than those in group D (27.5％ vs.7.5％,37.5％ vs.15％) (P＜0.05).Conclusion Compare with laryngoscope for intubation and auscultation positioning,Disposcope endoscope used for Univent tube intubation and positioning needs shorter time for intubation and positioning,higher successful one-time intubation ratio,less positioning adjustment.It also reduces the incidence of intubation complications.

Airway obstruction by dislodgement of an endobronchial tumor fragment during right lung lobectomy using a bronchial blocker: A case report

Dislodgement of tumor fragment with airway obstruction in a dependent bronchus can be a cause of severe hypoxemia, which is a rare but very serious complication of lung surgery. We describe a case of airway obstruction following deflation of a balloon of a bronchial blocker of a Univent tube during right bilobectomy. Following reintubation with a single lumen tube, the patient was simultaneously extubated with the biopsy forceps holding the mass. This report underlines that anesthesiologist should be alert to a possibility of airway obstruction following deflation a balloon of a bronchial blocker.

High Frequency Jet Ventilation of One Lung using a Bronchial Blocker of Univent during Carinal Resection

Airway management during carinal resection should provide adequate ventilation and oxygenation as well as a good surgical field, but without complications such as barotraumas or aspiration. One method of airway management is high frequency jet ventilation (HFJV) of one lung or both lungs. We describe a patient undergoing carinal resection, who was managed with HFJV of one lung, using a de-ballooned bronchial blocker of a Univent tube without cardiopulmonary compromise. HFJV of one lung using a bronchial blocker of a Univent tube is a simple and safe method which does not need additional catheters to perform HFJV and enables the position of the stiffer bronchial blocker more stable in airway when employed during carinal resection.

Use of Univent Tube(R) for Tracheal Gas Insufflation during Laparoscopic Surgery / 대한마취과학회지

BACKGROUND: Laparoscopic surgery is replacing conventional surgical techniques due to its many advantages. However the possibility of respiratory complications during CO2-induced pneumoperitoneum remain. Tracheal gas insufflation (TGI) has been shown to be a useful adjunct to mechanical ventilation in hypercapneic patients. This study investigated the effectiveness of TGI in reducing the PaCO2 level in hypercapneic patients during laparoscopic surgery without increasing the peak inspiratory pressure (PIP) and usefulness of a Univent tube(R) as a device for TGI. METHODS:Twenty-four patients who were scheduled to undergo gynecological laparoscopic surgery, were enrolled in this study. Anesthesia was induced and maintained with propofol, rocuronium and N2O-O2-sevoflurane. The suction port of the endobronchial blocker of the Univent tube(R) was used for the path of TGI. Data including the ABGA and respiratory parameters were measured three times, the pre-CO2 peritoneum (pre-CO2 pneumoperitoneum point, PCP), 15 min after CO2 peritoneum (after-CO2 pneumoperitoneum point, ACP) and after 15 min TGI (TGI point, TGIP). RESULTS: At ACP, the PaCO2 and PIP had increased more significantly than PCP. After TGI, the PaCO2 was decreased more significantly than ACP, but the PIP did not increased. CONCLUSIONS: TGI is a useful adjunct to mechanical ventilation in hypercapneic patients during laparoscopic surgery, and a univent tube(R) is an economic and convenient device for TGI.

One Lung Ventilation Using a Univent(R) Tube in a Patient with Permenant Tracheostomy after Total Laryngectomy: A case report / 대한마취과학회지

Which tube is the best one for the one lung ventilation? It is open to discussion of tube choice for the patient with tracheostomy after total laryngectomy. In this situation, we can use the bronchial blocker. We report the case of using a Univent(R) tube in a patient with tracheostomy after total laryngectomy for one lung ventilation. Successfully, the patient received esophagectomy, esophageal reconstruction and pyloroplasty due to esophageal cancer without any complications.

Clinical Evaluation of Univent tube in Airway Management during Video-Assisted Thoracoscopic Surgery / 中国微创外科杂志

Objective To evaluate the value of Univent tube in the airway management during one-lung ventilation. Methods A total of 40 patients with pneumothorax undergoing video-assisted thoracoscopic surgery (VATS) were randomly divided into Univent (U) and double-lumen tube (Robertshaw) (D) groups (20 in each). In U group, intubation was performed under the guidance of a fibreoptic bronchoscope; while in D group, the position of the tube was confirmed using fibreoptic bronchoscopy after intubation. The time of intubation, number of secondary dislodgements, quality of lung deflation, peak airway pressure during one-lung ventilation, and blood artery gas analysis data in the two groups were recorded 30 minutes after one-lung ventilation. Results The intubation time in U group was significantly longer than that in D group [(6.18?1.26) min vs (3.26?0.82) min, t=8.654, P=0.000]. The number of secondary dislodgements was 7 in U group, and 5 in D group(U=187.500, P=0.663). No significant difference was detected in the quality of lung deflation between the two groups, (U group: 15 excellent, 3 fair, and 2 poor; D group: 17 excellent, 2 fair, and 1 poor;U=179.500, P=0.583). The peak airway pressure during one-lung ventilation in U group was significantly lower than that in D group [(15.3?3.5) cm H2O vs (21.4?6.6) cm H2O, t=-3.649, P=0.001]; and the oxygen pressure in group U was significantly higher than that in group D [(303.8?65.7) mm Hg vs (258.4?72.9) mm Hg, t=2.066, P=0.046]. No significant difference was found in carbon dioxide pressure and oxygen saturation between the two groups. Conclusion During VATS, univent tube showed the same effectiveness and safety as DLT for one-lung ventilation.

The Sealing Volume and Pressure of the Bronchial Blocker Cuff of Univent(R) Tubes / 대한마취과학회지

BACKGROUND: The manufacturer has recommended that 6-7 ml of air be used to seal the bronchial blocker cuff of Univent tubes high pressure type. However overinflation of the cuff might result in pressure damage to mucosa. This study was performed to evaluate the appropriate sealing volume and pressure of the bronchial blocker cuff. METHODS: Univents were inserted in 26 patients. The bronchial blocker was connected to a pressure gauge and the cuff was inflated by 0.5 ml increment until the bronchus was sealed in supine and lateral positions under 20-25 mmHg airway pressure. The sealing volume and pressure were recorded. RESULTS: In males, the sealing volume for the left bronchus (3.8 +/- 0.4 ml) was smaller than for the right bronchus (5.4 +/- 1.0 ml) in both positions significantly (p < 0.05). In females, the sealing volume for the left bronchus (2.8 +/- 0.4 ml in both positions) was smaller than the volume for the right bronchus (3.7 +/- 0.8 ml in supine position, 3.9 +/- 0.9 ml in lateral position) significantly (p < 0.05). The sealing volume for females was smaller than for males significantly (p < 0.05), for all sealing pressures, there were no significant differences statistically. CONCLUSIONS: The bronchial blocker of Univent is a high pressure type and the sealing volume is higher for the right bronchus than for the left bronchus. Furthermore the sealing volume is less than the volume which is recommended by the manufacturer.

The Degree of Bronchial Mucosal Damages Related to the Bronchial Blocker Cuff Pressure of Univent(R) Tube / 대한마취과학회지

Background: Univent(R) tube was designed to overcome the disadvantages of double lumen endotracheal tube for one lung anesthesia. But overinflation of the blocker cuff of an endobronchial tube can cause pressure damage to the bronchus. The purpose of this study was to evaluate whether the blocker cuff pressure and the duration of ballooning using the Univent(R) tube is correlated with the degree of bronchial mucosal damage (BMD). Methods: A total of 13 men and 7 women intubated with the Univent(R) tube were enrolled for the study. The BMD were evaluated by direct visualization using fiberoptic bronchoscopy prior to intubation and following extubation and the degree of the BMD were scored from 0 to 4 as follows; 0: normal, 1: erythema, 2: swelling, 3: hemorrhage, 4: mucosal wall tearing. Results: No change in bronchial mucosa (score 0) were observed in 11 patients (55%), erythema (score 1) in 5 patients (25%), swelling (score 2) in 3 patients (15%), hemorrhage (score 3) in 1 patient (5%) and mucosal wall tearing (score 4) is none in 20 patients. The bronchial blocker cuff pressure required to "just sealing" the bronchus was 178.1+/-37.4 mmHg with corresponding cuff volume of 6.7+/-1.0 cc. The duration of ballooning was 115.5+/-26.4 min. The correlation coefficient between the blocker cuff pressure and duration of ballooning to the degree of bronchial mucosal damage were 0.125 and 0.137, respectively, which was not statistically significant. Conclusions: The bronchial blocker of Univent(R) tube doesn't cause any severe BMD and the degree of BMD are correlated with neither the bronchial blocker cuff pressure nor duration of ballooning of Univent(R) tube.

Bronchial Cuff Volume of Univent Tube for One Lung Ventilation / 대한마취과학회지

BACKGROUND: The univent tube is an endotracheal tube with a movable bronchial blocker for one lung ventilation. The purpose of this study was to measure the appropriate cuff volume sealing the mainstem bronchus by three different techniques. METHODS: This study was performed in 60 adult patients undergoing thoracotomy. 1) The negative pressure was applied to the end of blocker causing loss of volume in the breathing system. The blocker cuff volume was measured at the point of the bag ceased to deflate. 2) The blocker cuff volume was measured when breathing sound is not heard on blocked lung. 3) Then the capnometer was applied to the blocker and the cuff volume was measured at the point of the CO2 wave ceased abruptly. The bronchial blocker volumes from these three methods were compared with the volume which was measured when the lung was completely collapsed in operation field. RESULTS: Left bronchial sealing volume was 2.7+/-?0.8 ml with negative pressure technique, 3.5+/-0.8 ml with auscultation, 3.2?1.2 ml with CO2 technique and 3.0+/-0.7 ml with complete lung collapse at operation field. Right bronchial sealing volume ranged 3.5+/-0.9 ml with negative pressure technique, 4.6+/-1.0 ml with auscultation, 3.9+/-0.6 ml with CO2 technique and 4.2+/-0.9 ml with complete lung collapse at operation field. CONCLUSIONS: We concluded that right bronchial blocker volume was 4.2+/-0.9 ml and left bronchial blocker volume was 3.0+/-0.7 ml. The right bronchial blocker volume was larger than the left.

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.