Selective lobar blockade with a Coopdech blocker combined with a double-lumen endotracheal tube for lung metastases resection by laser

Patricia Cruz; Hugo David Orozco; Ignacio Garutti Martinez; Gloria Hernández Fernández

doi:10.1016/j.bjane.2016.02.005

Clinical Information

Selective lobar blockade with a Coopdech blocker combined with a double-lumen endotracheal tube for lung metastases resection by laser

Bloqueio lobar seletivo com um bloqueador Coopdech combinado com um tubo endotraqueal de duplo lúmen para ressecção de metástases pulmonares com laser

Patricia Cruz; Hugo David Orozco; Ignacio Garutti Martinez; Gloria Hernández Fernández

http://dx.doi.org/10.1016/j.bjane.2016.02.005 Braz J Anesthesiol, vol.68, n2, p.200-204, 2018

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Abstract

Abstract In recent years, laser resection of lung metastases has been established as the standard procedure worldwide. To avoid airway fire, it is necessary to collapse the surgical lung. The selective lobar bronchial blockade is a technique that allows one-lung ventilation while the operated lobe is collapsed in patients with previous pulmonary resection requiring subsequent resection or with limited pulmonary reserve. We report a clinical case about our experience of a selective lobar bronchial blockade technique with a bronchial blocker (Coopdech endobronchial blocker) that was employed successfully with a double-lumen endotracheal tube in a patient with previous contralateral pulmonary resection who was scheduled for atypical resections of pulmonary metastases by laser. We selectively blocked the right intermediate bronchus for management of hypoxemia during one-lung ventilation. This technique provided adequate ventilation and oxygenation during surgery, avoiding the need of two-lung ventilation during lung metastases resection by laser. Conclusion: This case shows that if a properly positioned double-lumen tube was already in place and the patient does not tolerate one-lung ventilation because of hypoxemia, it would be possible to provide selective lobar blockade by placing a bronchial blocker through the lumen of the double-lumen tube, avoiding the use of continuous positive airway pressure during laser surgery. This technique does not disturb the operative field or interrupt the operative procedure during resection by laser, which would occur during two-lung ventilation or used of continuous positive airway pressure.

Keywords

Bronchial blocker, One-lung ventilation, Laser, Thoracic surgery

Resumo

Resumo Nos últimos anos, a ressecção de metástases pulmonares com o uso de laser foi estabelecida como o procedimento padrão em todo o mundo. Para evitar queimadura das vias aéreas, o colapso cirúrgico do pulmão é necessário. O bloqueio brônquico seletivo é uma técnica que permite a ventilação de um lobo, enquanto o lobo operado é colapsado nos pacientes com ressecção pulmonar anterior que requerem ressecção subsequente ou que possuem reserva pulmonar limitada. Relatamos um caso clínico de nossa experiência com a técnica de bloqueio brônquico seletivo com bloqueador brônquico (bloqueador endobrônquico Coopdech), usado com sucesso com um tubo endotraqueal de duplo lúmen em um paciente com ressecção pulmonar contralateral prévia, agendado para ressecção atípica de metástases pulmonares com o uso de laser. Seletivamente bloqueamos o brônquio intermediário direito para o controle de hipoxemia durante a ventilação monopulmonar. Essa técnica proporcionou ventilação e oxigenação adequadas durante a cirurgia, evitando a necessidade de ventilar os dois pulmões durante a ressecção de metástases pulmonares com o uso de laser. Conclusão: Este caso mostra que, se um tubo de duplo lume estiver corretamente posicionado e o paciente não tolerar a ventilação monopulmonar devido à hipoxemia, seria possível fornecer bloqueio lobar seletivo com a colocação de um bloqueador brônquico através do lume do tubo de duplo lume, evitando o uso de pressão positiva contínua de vias aéreas (PPCVA) durante a cirurgia a laser. Essa técnica não interfere no campo operatório ou interrompe o procedimento durante a ressecção por laser, que poderia ocorrer durante a ventilação dos dois pulmões ou uso de PPCVA.

Palavras-chave

Bloqueador bronquial, Ventilação monopulmonar, Laser, Cirurgia torácica

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Selective lobar blockade with a Coopdech blocker combined with a double-lumen endotracheal tube for lung metastases resection by laser

Bloqueio lobar seletivo com um bloqueador Coopdech combinado com um tubo endotraqueal de duplo lúmen para ressecção de metástases pulmonares com laser

Patricia Cruz; Hugo David Orozco; Ignacio Garutti Martinez; Gloria Hernández Fernández

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