Clinically-guided placement of fogarty catheter for lung isolation in video-assisted thoracoscopic surgery for spontaneous pneumothorax

ABSTRACT

Over the past decade, video assisted thoracic surgery [VATS] has changed the way spontaneous pneumothorax [SP] is managed. During VATS one-lung ventilation [OLV] is strictly indicated. Successful use of Fogarty occlusion embolectomy catheters has been reported. This study aimed to evaluate the efficiency and safety of Fogarty catheters as bronchial blockers for patients undergoing VATS for spontaneous pneumothorax and using the fiberoptic bronchoscope to assess the successful placement of such catheters when inserted depending on clinically-guided technique including initial temporary deliberate endobrinchial intubation. Eleven patients with SP for VATSbuulectomy and pleural abrasion were enrolled. All patients received standardized balanced general anesthetic technique and VATS technique by a single anesthesiologist and surgein.The lung isolation technique depends on deliberate temporary intubation of the main bronchusin the ipsilateral surgical side with a single-lumen endotracheal tube and advancing a 8/22F Fogarty catheter past the tip of the endobronchial tube. The endobronchial tube is then removed and a new endotracheal tube is placed alongside the Fogarty catheter. We measured the success rate and time needed to achieve placement of the Fogarty catheter. W e also confirmed proper positioning with fiberoptic bronchoscope and recorded results. Verbal analog scale was used to describe the surgical satisfaction about lung isolation. One left sided case failed to be intubated without bronchoscopy. Success was significantly higher in right sided cases [100% versus80% in left sided] and needed significantly shorter time to be achieved [328.2 +/- 23. 2 seconds versus 757.9 +/- 51.5 seconds respectively]. Verbal analog scale scored a mean of 78.5 +/- 13mm out of 100mm. This study showed that Fogarty catheter can be placed in a clinically-guided technique safely with satisfactory lung isolation in patients undergoing video-assisted thoracoscopic surgery for spontaneous pneumothorax