Abstract
Introduction
Double lumen tube (DLT) intubation is used for lung isolation but is not without disadvantages including increased intubation time, anesthesia expertise, risk of airway trauma, and costs over single lumen tube (SLT) intubation. SLT intubation with CO2 insufflation can be used as an alternative for lung isolation. We reviewed our experience with this technique during thoracoscopic surgery.
Methods
We performed a retrospective review of a prospectively maintained IRB-approved database from 2009 to 2018. Operations were performed with CO2 insufflation up to 15 mmHg. Indications for surgery, operative details, intraoperative complications, pathology, and postoperative complications were reviewed.
Results
We identified 123 patients (70 females [57%]) with a median age of 40 years (range 16–80 years) and a median BMI of 26.2 kg/m2 (range 15–59 kg/m2) that underwent minimally invasive thoracoscopic procedures with this technique. Procedures included: mediastinal mass resection or biopsy (41%), sympathectomy (37%), wedge resection (10%), first rib resection (6%), diaphragm plication (2%), segmentectomy (2%), decortication (2%), pleural biopsy (2%), and pericardial cyst resection (1%). Median operative time was 90 min (range 25–584 min) and median intraoperative blood loss was 10 mL (range 2–200 mL). Intraoperative hemodynamic parameters were obtained at procedure start, 1 h after CO2 insufflation, and at procedure completion: we observed significant changes in heart rate and systolic blood pressure (P = 0.027 and P < 0.001, respectively) although clinically inconsequential. Mean end-tidal CO2 1 h after insufflation was 36.6 ± 4.5 mmHg. There were no intraoperative complications and no conversions to a DLT. Median length of stay was 1 day (range 0–14 days). Five complications (4%) were observed and no mortalities.
Conclusions
SLT intubation and CO2 insufflation is a feasible and safe alternative to DLT intubation for lung isolation. This can be a useful strategy to accomplish lung isolation for some thoracoscopic procedures, in particular when expertise for DLT placement is unavailable.
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References
Cerfolio RJ, Bryant AS, Sheils TM, Bass CS, Bartolucci AA (2004) Video-assisted thoracoscopic surgery using single-lumen endotracheal tube anesthesia. Chest 126:281–285. https://doi.org/10.1378/chest.126.1.281
Horswell JL (1993) Anesthetic techniques for thoracoscopy. Ann Thorac Surg 56:624–629
Knoll H, Ziegeler S, Schreiber J-U, Buchinger H, Bialas P, Semyonov K, Graeter T, Mencke T (2006) Airway injuries after one-lung ventilation: a comparison between double-lumen tube and endobronchial blocker: a randomized, prospective, controlled trial. Anesthesiology 105:471–477
Misthos P, Katsaragakis S, Milingos N, Kakaris S, Sepsas E, Athanassiadi K, Theodorou D, Skottis I (2005) Postresectional pulmonary oxidative stress in lung cancer patients. The role of one-lung ventilation. Eur J Cardio-Thorac Surg 27:379–382 (discussion 382–383). https://doi.org/10.1016/j.ejcts.2004.12.023
Miller DL, Force SD (2007) Outpatient microthoracoscopic sympathectomy for palmar hyperhidrosis. Ann Thorac Surg 83:1850–1853. https://doi.org/10.1016/J.ATHORACSUR.2006.11.030
Wong RY, Fung ST, Jawan B, Chen HJ, Lee JH (1995) Use of a single lumen endotracheal tube and continuous CO2 insufflation in transthoracic endoscopic sympathectomy. Acta Anaesthesiol Sin 33:21–26
Sancheti MS, Dewan BP, Pickens A, Fernandez FG, Miller DL, Force SD (2013) Thoracoscopy without lung isolation utilizing single lumen endotracheal tube intubation and carbon dioxide insufflation. Ann Thorac Surg 96:439–444. https://doi.org/10.1016/j.athoracsur.2013.04.060
Ohtsuka T, Imanaka K, Endoh M, Kohno T, Nakajima J, Kotsuka Y, Takamoto S (1999) Hemodynamic effects of carbon dioxide insufflation under single-lung ventilation during thoracoscopy. Ann Thorac Surg 68:29–32 (discussion 32–33)
Wolfer RS, Krasna MJ, Hasnain JU, McLaughlin JS (1994) Hemodynamic effects of carbon dioxide insufflation during thoracoscopy. Ann Thorac Surg 58:404–407 (discussion 407–408)
Tran DTT, Badner NH, Nicolaou G, Sischek W (2010) Arterial pCO2 changes during thoracoscopic surgery with CO2 insufflation and one lung ventilation. HSR Proc Intensive Care Cardiovasc Anesth 2:191–197
Mao Q-X, Guo W, Huang B-Q, Yan H (2016) Impact of artificial capnothorax on coagulation in patients during video-assisted thoracoscopic esophagectomy for squamous cell carcinoma. Surg Endosc 30:2766–2772. https://doi.org/10.1007/s00464-015-4549-3
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Raul Caso, Colleen Hamm Kelly, M. Blair Marshall declare that they have no conflicts of interest or financial ties to disclose.
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Caso, R., Kelly, C.H. & Marshall, M.B. Single lumen endotracheal intubation with carbon dioxide insufflation for lung isolation in thoracic surgery. Surg Endosc 33, 3287–3290 (2019). https://doi.org/10.1007/s00464-018-06614-9
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DOI: https://doi.org/10.1007/s00464-018-06614-9