Surgical Endoscopy

, Volume 18, Issue 12, pp 1752–1756

Facilitation of alternative one-lung and two-lung ventilation by use of an endotracheal tube exchanger for pediatric empyema during video-assisted thoracoscopy

  • A. C. Y. Ho
  • H.-S. Chung
  • P.-P. Lu
  • C.-L. Hong
  • M.-W. Yang
  • H.-P. Liu
Original article

Abstract

Background

Video-assisted thoracoscopic surgery (VATS) has emerged as an innovative and popular procedure for the management of postpneumonic empyema in children refractory to medical response. Alternative uses of two- and one-lung ventilations have been required during VATS. This study evaluated the efficacy of alternating one- and two-lung ventilation through intraoperatively through the same single-lumen endobronchial tube using a tube exchanger during a thoracoscopic procedure for pediatric empyema.

Methods

Between May 1995 and August 2001, 62 consecutive pediatric patients undergoing VATS for evacuation of the loculated empyema cavity were studied. The same single-lumen endobronchial tube was used, with an indwelling endotracheal tube exchanger in place for readjustment of the tube position to provide alternation of one- and two-lung ventilations in a thoracosopic procedure. Duration of operation, heart rate, mean arterial pressure, peak airway pressure, an partial pressure of oxygen (PaO2) and carbon dioxide (PaCO2) changes during one- and two-lung ventilations were recorded. The quality of lung deflation and inflation was rated by the surgeon using direct visualization as excellent, fair or poor.

Results

The mean operating time was 90 min (range, 50–120 min). No differences were found in heart rate, mean arterial pressure, or PaO2 during one- and two-lung ventilations. Peak airway pressure and PaCO2 during two-lung ventilation were significantly higher than during one-lung ventilation. The quality of lung deflation and inflation was judged excellent for all the patients.

Conclusions

The VATS procedure can be performed safely and effectively in children using proper anesthetic technique. Retention of a tube exchanger within a single-lumen endobronchial tube an easily provide alternative one- and two-lung ventilations without inducing any significant airway flow obstruction during the operation.

Keywords

Pediatric empyema Video-assisted thoracoscopy VATS Intubation device Single-lumen endobronchial tube Tube exchanger 

References

  1. 1.
    Benumof, JL, Alfery, DD 1994

    Anesthesia in thoracic surgery

    Miller, Ronald D eds. AnesthesiaChurchill LivingstoneNew York16901693
    Google Scholar
  2. 2.
    Burton, NA, Watson, DC, Brodsky, JB, Mark, JB 1983Advantages of a new polyvinyl chloride double-lumen tube in thoracic surgeryAnn Thorac Surg367884CrossRefPubMedGoogle Scholar
  3. 3.
    Conacher, ID 1982The urinary catheter as a bronchial blockerAnesthesia38457475Google Scholar
  4. 4.
    Dalens, B, Labbe, A, Haberer, JP 1982Selective endobronchial blocking vs selective intubationAnesthesiology57555556CrossRefPubMedGoogle Scholar
  5. 5.
    Ginsberg, RJ 1981New technique for one lung anesthesia using an endobronchial blockerJ Thorac Cardiovasv Surg82542546Google Scholar
  6. 6.
    Hogg, CE, Lorhan, PH 1970Pediatric bronchial blockingAnesthesiology33560562CrossRefPubMedGoogle Scholar
  7. 7.
    Inoue, H, Shohtsu, A, Ogawa, J, Kawada, S, Koide, S 1982New device for one-lung anesthesia: endotracheal tube with movable blockerJ Thorac cardiovasc Surg83940941PubMedGoogle Scholar
  8. 8.
    Kawaya, H, Krishna, PR 1985New endotracheal tube (Univent tube) for selective blockade of one lungAnesthesiology63143242CrossRefGoogle Scholar
  9. 9.
    Kern, JA, Rodges, BM 1993Thoracoscopy in the management empyema in childrenJ Pediatr Surg2811281132CrossRefPubMedGoogle Scholar
  10. 10.
    Kerr, JH 1972Physiological aspects of one-lung (endobronchial) anesthesia in thoracic surgeryInt Anesthesiol Clin1061CrossRefPubMedGoogle Scholar
  11. 11.
    Khanam, T, Branthwaite, MA 1973Arterial oxygenation during one-lung anaesthesiaAnesthesia28280CrossRefGoogle Scholar
  12. 12.
    Kubota, H, Kubota, Y, Toyoda, Y, Ishida, H, Asada, A, Matsuura, H 1987Selective blind endobronchial intubation in children and adultsAnesthesiology67587589CrossRefPubMedGoogle Scholar
  13. 13.
    Landreneau, RJ, Keenan, RJ, Hazelrigg, SR, Mack, MJ, Naunheim, KS 1996Thoracoscopy for empyema and hemothoraxChest1091824CrossRefPubMedGoogle Scholar
  14. 14.
    Lieberman, ID, Littleford, J, Horan, T, Unruh, H 1996Placement of left double-lumen endobronchial tubes with or without a styletCan J Anaesth43238242CrossRefPubMedGoogle Scholar
  15. 15.
    Liu, HP, Hsieh, MJ, Lu, HI, Liu, YH, Wu, YC, Lin, PJ 2002Thoracoscopic-assisted management of postpneumonic empyema in children refractory to medical responseSurg Endosc1616121614CrossRefPubMedGoogle Scholar
  16. 16.
    Silen, ML, Naunheim, KS 1996Thoracoscopic approach to the management of empyema thoracic: indications and resultsChest Surg Clin North Am6491499Google Scholar
  17. 17.
    Stovroff, M, Tegue, G, Heiss, KF, Parker, P, Ricketts, RR 1998Thoracoscopy empyema in childrenJ Pediatr Surg33708710CrossRefGoogle Scholar
  18. 18.
    Watson, CB, Bowe, EA, Burk, W 1982One-lung anesthesia for pediatric thoracic surgery: a new use for the fiberoptic bronchoscopeAnesthesiology56314315CrossRefPubMedGoogle Scholar
  19. 19.
    Wood, RE, Campbell, D, Rassuk, MA 1972Surgical advantages of selective unilateral ventilationAnn Thorac Surg14173180CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • A. C. Y. Ho
    • 1
  • H.-S. Chung
    • 1
  • P.-P. Lu
    • 1
  • C.-L. Hong
    • 1
  • M.-W. Yang
    • 1
  • H.-P. Liu
    • 2
  1. 1.Department of AnesthesiaChang Gung Memorial HospitalKweishanTaiwan
  2. 2.Department of Thoracic and Cardiovascular SurgeryChang Gung Memorial HospitalKweishanTaiwan

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