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Lung isolation in thoracic anesthesia, state of the art

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Summary

Although the incidence of cases with the original indications for lung isolation such as abscess and hemoptysis has decreased, lung isolation is required with increasing frequency in an ever-widening spectrum of clinical situations. The preference of anesthesiologists has oscillated between bronchial blockers and single or double-lumen tubes for the past 50 yr. At present, double-lumen tubes continue to have the widest application for providing safe reliable lung separation in the majority of cases. However the optimal method of lung isolation in any individual case will depend on multiple factors which include the patient’s underlying pathology and anatomy and the skill and training of the anesthesiologist.

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References

  1. Gale JW, Waters RM. Closed endobronchial anesthesia in thoracic surgery. Anesth Analg 1932; 11: 283–5.

    Article  Google Scholar 

  2. Mushin WW, Rendell-Baker L. The origins of Thoracic Anesthesia. Wood Library. Museum of Anesthesiology, Park Ridge IL, 1953, reprinted 1991.

    Google Scholar 

  3. Bjork VO, Carlens E. The prevention of spread during pulmonary resection surgery by the use of a doublelumen catheter. J Thorac Surg 1950; 20: 151–7.

    CAS  PubMed  Google Scholar 

  4. Jenkins A V, Clarke G Endobronchial anaesthesia with the Carlen’s catheter. Br J Anaesth 1958; 30: 13–50.

    Article  CAS  PubMed  Google Scholar 

  5. Schweizer A, dePerrot M, Hohn L, Spiliopoulos A, Licker M Massive contralateral pneumonia following thoracotomy for lung resection. J Clin Anesth 1998; 10: 678–80.

    Article  CAS  PubMed  Google Scholar 

  6. Horswell Jl. Anesthetic techniques for thoracoscopy. Ann Thorac Surg 1993; 56: 624–9.

    Article  CAS  PubMed  Google Scholar 

  7. Adoumie R, Shennib H, Brown R, et al. Differential lung ventilation. J Thoracic Cardiovasc Surg 1993; 105: 229–34.

    CAS  Google Scholar 

  8. Cohen JA, Denisco RA, Richards TS, et al. Hazardous placement of a Robertshaw-type endobronchial tube. Anesth Analg 1986; 65: 100–3.

    Article  CAS  PubMed  Google Scholar 

  9. Wells DG, Zecler J, Podolakin W, et al. Cardiac arrest from pulmonary outflow tract obstruction due to a double-lumen tube. Anesthesiology 1987; 66: 422–5.

    Article  CAS  PubMed  Google Scholar 

  10. Herenstein R, Russo JR, Moonka N, et al. Management of one-lung anesthesia in an anticoagulated patient. Anesth Analg 1988; 67: 1120–3.

    Article  CAS  PubMed  Google Scholar 

  11. Robertshaw FL. Low resistance double-lumen endobronchial tubes. Br J Anaesth 1962; 34: 576–71.

    Article  CAS  PubMed  Google Scholar 

  12. Neto PPR Bronchial cuff pressure: comparison of Carlens and polyvinyl chloride double lumen tubes. Anesthesiology 1987; 66: 255–9.

    Article  Google Scholar 

  13. Benumof JL, Partridge BL, Salvatierra C, Keating, J. Margin of safety in positioning modern doublelumen endotracheal tubes. Anesthesiology 1987: 67: 729–38.

    Article  CAS  PubMed  Google Scholar 

  14. Watterson LM, Harrison GA A comparison of the endobronchial segment of modern left-sided doublelumen tubes in anesthesia for bilateral sequential lung transplantation. J Cardiothorac Vasc Anesth 1996; 10: 583–5.

    Article  CAS  PubMed  Google Scholar 

  15. Slinger P, Lesiuk L. Flow resistances of disposable double-lumen, single-lumen, and Univent tubes. J Cardiothorac Vasc Anesth 1998; 12: 133–6.

    Article  CAS  PubMed  Google Scholar 

  16. Campos JH, Massa CF, Kernstein KH. The incidence of right upper lobe collapse when comparing a rightsided double-lumen tube versus a modified left doublelumen tube for left-sided thoracic surgery. Anesth Analg 2000; 90: 535–40.

    Article  CAS  PubMed  Google Scholar 

  17. Wagner DL, Gammage GW, Wong ML. Tracheal rupture following the insertion of a double-lumen endotracheal tube. Anesthesiology 1985; 63: 698–700.

    Article  CAS  PubMed  Google Scholar 

  18. Hannallah MS, Gharagozloo F, Gomes MN, Chase GA. A comparison of two techniques of left doublelumen tube bronchial cuff inflation in producing water-tight seal of the left mainstem bronchus. Anesth Analg 1998; 87: 1027–31.

    CAS  PubMed  Google Scholar 

  19. Brodsky JB, Adkins MO, Gaba DM. Bronchial cuff pressures of double-lumen tubes, Anesth Analg 1989; 69: 608–10.

    Article  CAS  PubMed  Google Scholar 

  20. Hannallah MS, Benumof JL, Bachenheimer LC, Mundt DJ. The resting volume and compliance characteristics of the bronchial cuff of left polyvinyl chloride doublelumen endobronchial tubes. Anesth Analg 1993; 77: 1222–6.

    CAS  PubMed  Google Scholar 

  21. Brodsky JB, Macario A, Mark JBD. Tracheal diameter predicts double-lumen tube size: a method for selecting left double-lumen tubes. Anesth Analg 1996; 82: 861–4.

    CAS  PubMed  Google Scholar 

  22. Chow MYH, Liaw BL, Lew TWK, Chelliah RY, Ong BC. Predicting the size of a double-lumen tube based on tracheal diameter. Anesth Analg 1998; 87: 158–60.

    CAS  PubMed  Google Scholar 

  23. Hannallah M, Benumof JL, Silverman PM, Kelly LC, Lea D. Evaluation of an approach to chosing a leftsided double-lumen tube size based on chest computed tomographic scan measurement of left mainstem bronchial diameter. J Cardiothorac Vasc Anesth 1997; 11: 168–71.

    Article  CAS  PubMed  Google Scholar 

  24. Lieberman D, Littleford J, Horan T, et al. Placement of leftdouble-lumen endobronchial tubes with or without stylet. Can J Anesth 1996; 43: 238–42.

    Article  CAS  PubMed  Google Scholar 

  25. Cheong KF, Koh KF. Placement of left-sided doublelumen tubes: comparison of clinical and fiberopticguided placement. Br J Anaesth 1999; 82: 920–1.

    Article  CAS  PubMed  Google Scholar 

  26. Brodsky JB, Benumof JL, Ehrenworth J. Depth of placement of left double-lumen tubes. Anesth Analg 1991; 73: 570–6.

    Article  CAS  PubMed  Google Scholar 

  27. Sakuragi T, Kumano K, Yasumoto M, Dan K. Rupture of the left main-stem bronchus by the tracheal portion of a double-lumen endobronchial tube. Acta Anaesthesiol Scand 1997; 41: 1218–20.

    Article  CAS  PubMed  Google Scholar 

  28. Desiderio DP, Burt M, Kolker AC, et al. The effects of endobronchial cuff inflation on double-lumen tube movement after lateral decubitus positioning. J Cardiothorac Vasc Anesth 1997; 11: 595–8.

    Article  CAS  PubMed  Google Scholar 

  29. Campos JH, Reasoner DK, Moyers JR. Comparison of a modified double-lumen endotracheal tube with a single-lumen tube with enclosed bronchial blocker. Anesth Analg 1996; 83: 1268–72.

    Article  CAS  PubMed  Google Scholar 

  30. Ginsburg RJ. New technique for one-lung anesthesia using an endobronchial blocker. J Thorac Cardiovasc Surg 1981; 82: 542–6.

    Google Scholar 

  31. Lnoue H. New device for one lung anesthesia, endotracheal tube with movable blocker. J Thorac Cardiovasc Surg 1982; 83: 940.

    Google Scholar 

  32. Ransom ES, Carter SL, Mund GD. Univent tube: a useful device in patients with difficult airways. J Cardiothorac Vasc Anesth 1995; 9: 725–7.

    Article  CAS  PubMed  Google Scholar 

  33. Arndt GA, Buchika S, Kranner PW, DeLessio ST. Wireguided endobronchial blockade in a patient with a li-s mited mouth opening. Can J Anesth 1999; 46: 87–9.

    Article  CAS  PubMed  Google Scholar 

  34. Kubota H, Kubota Y, Toyoda Y, Ishida H, Asada A, Matsuura H. Selective blind endobronchial intubation in children and adults. Anesthesiology 1987; 67: 587–9.

    Article  CAS  PubMed  Google Scholar 

  35. Newton JR, Grillo HC, Mathisen DJ. Main bronchial sleeve resection with pulmonary conservation. Ann Thorac Surg 1991; 52: 272–6.

    Article  Google Scholar 

  36. Lobato EB, Risley WP, Stolzfus DP. Intraoperative management of distal tracheal rupture with selective bronchial intubation. J Clin Anesth 1997; 9: 155–8.

    Article  CAS  PubMed  Google Scholar 

  37. Shinnick JP, Freedman ABP. Bronchofiberscopic placement of a double-lumen endotracheal tube. Crit Care Med 1982; 10: 544–5.

    Article  CAS  PubMed  Google Scholar 

  38. Brodsky JB, Macario A, Cannon WB, Mark JBD. “Blind” placement of plastic left double-lumen tubes. Anaesth Intensive Care 1995; 23: 583–6.

    CAS  PubMed  Google Scholar 

  39. Alliaume BE, Coddens J, Deloof T. Reliability of auscultation in positioning of double-lumen endobronchial tubes. Can J Anaesth 1992; 39: 687–90.

    Article  CAS  PubMed  Google Scholar 

  40. Klein U, Karzai W, Bloos F, et al. Role of fiberoptic bronchoscopy in conjunction with the use of doublelumen tubes for thoracic anesthesia. Anesthesiology 1998: 88: 346–50.

    Article  CAS  PubMed  Google Scholar 

  41. Sherry K Management of patients undergoing oesophagectomy.In: Gray AJG, Hoile RW, Ingram GS, Sheryy KM (Eds.). The Report of the National Confidential Enquiry into Perioperative Deaths 1996/1997. London, 1998: 57–61.

  42. Pennefather SH, Russel GN. Placement of doublelumen tubes-time to shed light on an old problem. Brit J Anaesth 2000; 84: 308–10.

    Article  CAS  PubMed  Google Scholar 

  43. Slinger P. Fiberoptic positioning of double-lumen tubes. J Cardiothorac Anesth 1989; 3: 486–96.

    Article  CAS  PubMed  Google Scholar 

  44. Saito S, Dohi S, Tajima K. Failure of double-lumen endobronchial tube placement: congenital tracheal stenosis in an adult. Anesthesiology 1987; 66: 83–6.

    Article  CAS  PubMed  Google Scholar 

  45. Bayes J, Salter EM, Hadberg PS, Lawson D. Obstruction of a double-lumen tube by a saber-sheath trachea. Anesth Analg 1994; 79: 186–8.

    Article  CAS  PubMed  Google Scholar 

  46. Smith GB, Hirsch NP, Ehrenworth J. Placement of double-lumen endobronchial tubes. Br J Anaesth 1986; 58: 1317–21.

    Article  CAS  PubMed  Google Scholar 

  47. Cheong KF, Koh KF. Placement of left-sided doublelumen endobronchial tubes: comparison of clinical and fiberoptic-guided placement. Brit J Anaesth 1999; 82: 920–1.

    Article  CAS  PubMed  Google Scholar 

  48. Slinger P, Chripko D A clinical comparison of bronchial cuff pressures in disposable left doublelumen tubes. Anesth Analg 1993; 77: 305–9.

    Article  CAS  PubMed  Google Scholar 

  49. Kelley JG, Gaba DM, Brodsky JB. Bronchial cuff pressures of two tubes used in thoracic surgery. J Cardiothorac Vasc Anesth 1992; 6: 190–3.

    Article  CAS  PubMed  Google Scholar 

  50. Robertshaw FL. Low resistance double-lumen endobronchial tubes. Br J Anaesth 1962; 34: 576–80.

    Article  CAS  PubMed  Google Scholar 

  51. Nino M, Body SC, Hartigan PM The use of a bronchial blocker to rescue an ill fitting double-lumen endotracheal tube. Anesth Analg 2000; 91: 1370–1.

    Article  CAS  PubMed  Google Scholar 

  52. Barker SJ Clarke C, Trivedi N, Hyatt J, Fynes M, Roessler P. Anesthesia for thoracoscopic laser ablation of bullous emphysema. Anesthesiology 1993; 78: 44–50.

    Article  CAS  PubMed  Google Scholar 

  53. Horswell JL. Anesthetic techniques for thoracoscopy. Ann Thorac Surg 1993; 56: 624–9.

    Article  CAS  PubMed  Google Scholar 

  54. Robinson RJS, Slinger P, Mulder DS, Shennib H, Benumof JL, Rehder K Video-assisted thorascopic surgery using a singlelumen tube in spontaneously ventilating anesthetized patients: an alternative anesthetic technique. J Cardiothorac Vasc Anesth 1994; 8: 693–8.

    Article  CAS  PubMed  Google Scholar 

  55. Ravichandran PS, Kelly SP, Swanson J, Fessier CL, Starr A. Thermodilution catheter-induced endobronchial hemorrhage with pulmonary hypertension. Ann Thorac Surg 1991; 52: 1204.

    Article  Google Scholar 

  56. Shivaram U, Finch P, Nowak P. Plastic endobronchial tubes in the management of life-threatening hemoptysis. Chest 1987; 92: 1108–11.

    Article  CAS  PubMed  Google Scholar 

  57. Wang Y-L, Hong C-1, Chung HS, et al. Massive hemoptysis after initiation of positive pressure ventilation in a patient with pulmonary tuberculosis. Anesthesiology 2000; 92: 1480–2.

    Article  CAS  PubMed  Google Scholar 

  58. Devitt JH, McLean RF, Koch JP. Anesthetic management of acute blunt thoracic trauma. Can J Anaesth 1991; 38: 506–12.

    Article  CAS  PubMed  Google Scholar 

  59. Urschel JD, Myerowitz PD. Catheter-induced pulmonary artery rupture in the setting of cardiopulmonary bypass. Ann Thorac Surg 1993; 53: 585–9.

    Article  Google Scholar 

  60. Purut CM, Stewart SM, Parham JV, et al. Intraoperative management of severe endobronchial hemorrhage. Ann Thorac Surg 1991; 51: 304–7.

    Article  CAS  PubMed  Google Scholar 

  61. Patane PS, Sell BA, Mahla M Awake fiberoptic endobronchial intubation. J Caradiothorac Anesth 1990; 4: 229–31.

    Article  CAS  Google Scholar 

  62. Williams A, Kay J. Thoracic epidural anesthesia for thoracoscopy, rib resection and thoracotomy in a patient with a bronchopleural fistula postpneumonectomy. Anesthesiology 2000; 92: 1482–4.

    Article  CAS  PubMed  Google Scholar 

  63. Otruba Z, Oxorn D, Lobar bronchial blockade in bronchopleural fistula. Can J Anaesth 1992; 39: 176.

    Article  CAS  PubMed  Google Scholar 

  64. Spragg RG, Benumof JL, Alfery DD. New method for performance of unilateral lung lavage. Anesthesiology 1982; 57: 535–8.

    Article  CAS  PubMed  Google Scholar 

  65. Bussieres JS, St-Onge S, Saey D, et al. Feasability, safety and efficacity of whole lung lavage in silicosis. Can J Anesth 1999; 46: A43 (abstract).

    Google Scholar 

  66. Stow PJ, Grant J. Asynchronous independent lung ventilation. Anaesthesia 1985: 40: 163–6.

    Article  CAS  PubMed  Google Scholar 

  67. Ost D, Corbridge T. Independent lung ventilation. Clin Chest Med 1996; 17: 591–601.

    Article  CAS  PubMed  Google Scholar 

  68. Matot L, Gozal Y. Use of a double-lumen endobronchial tube for severe bronchospasm during cardiopulmonary bypass. J Cardiothorac Vasc Anesth 2000; 14: 579–80.

    Article  CAS  PubMed  Google Scholar 

  69. Anonymous. American Society of Anesthesiologists Guidelines. Anesthesiology 1993; 78: 597.

  70. Shulman GB, Connellly NR Double-lumen tube placement with the Bullard laryngoscope. Can J Anesth 1999; 46: 232–4.

    Article  CAS  PubMed  Google Scholar 

  71. Scanzillo MA, Shulman MS. Lighted stylet for placement of a double-lumen endobronchial tube. Anesth Analg 1995; 81: 205–6.

    Article  CAS  PubMed  Google Scholar 

  72. Hannallah M. Evaluation of tracheal tube exchangers for replacement of double-lumen tubes. Anesthesiology 1992; 77: 609–10.

    Article  CAS  PubMed  Google Scholar 

  73. Harvey SC, Alpert CC, Fishman RL. Independent placement of a bronchial blocker for single-lung ventilation: an alternative method for the difficult airway. Anesth Analg 1996; 83: 1330–1.

    Article  CAS  PubMed  Google Scholar 

  74. Kraenzler EJ, Rice TW, Stein SL, Lnsler SR Bilateral bronchial blockers for bilateral pulmonary resection in a patient with a previous laryngectomy. J Cardiothorac Vasc Anesth 1997; 11: 201–2.

    Article  CAS  PubMed  Google Scholar 

  75. Mitchell JB, Ward PM. The management of tracheal rupture using bilateral bronchial intubation. Anaesthesia 1993; 48: 222–5.

    Google Scholar 

  76. Ho AM-H Lee S, Tay BA, Chung DC Lung isolation for the prevention of air embolism in penetrating lung trauma. Can J Anesth 2000; 47: 1256–8.

    Article  CAS  PubMed  Google Scholar 

  77. Massard G, Rouge C, Dabbagh A Tracheobronchial lacerations after intubation and tracheostomy. Ann Thorac Surg 1996; 61: 1483–7.

    Article  CAS  PubMed  Google Scholar 

  78. Peden CJ, Galizia EJ, Smith RB. Bronchial trauma secondary to intubation with a PVC double-lumen tube. J Royal Soc Med 1992; 85: 705–6.

    CAS  Google Scholar 

  79. Gilbert GB, Goodsell CW, Krasna MJ Bronchial rupture by a double-lumen endobronchial tube during staging thoracoscopy. Anesth Analg 1999; 88: 1252–3.

    Article  CAS  PubMed  Google Scholar 

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Slinger, P. Lung isolation in thoracic anesthesia, state of the art. Can J Anesth 48 (Suppl 1), R13–R15 (2001). https://doi.org/10.1007/BF03028172

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