PROFESORES EXTRANJEROS Vol. 32. Supl. 1, Abril-Junio 2009 pp S220-S226. Lung separation techniques for thoracic surgery. Peter Slinger MD, FRCPC*
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1 medigraphic Artemisa en línea Anestesiología Mexicana de Revista ANTES C COLEGIO MEXICANO DE ANESTESIOLOGÍA A.C. SOCIEDAD MEXICANA DE ANESTESIOLOGÍA PROFESORES EXTRANJEROS Vol. 32. Supl. 1, Abril-Junio 2009 pp S220-S226 Lung separation techniques for thoracic surgery Peter Slinger MD, FRCPC* *Dept. Anesthesia, University of Toronto CARLENS DOUBLE-LUMEN ENDOBRONCHIAL TUBE Double-lumen tubes Bronchial blockers Video-laryngoscopy Tracheo-bronchial anatomy TECHNIQUES OF LUNG ISOLATION: Single lumen tubes Double-lumen tubes Bronchial blockers SINGLE LUMEN ENDOBRONCHIAL TUBES S220
2 8 FR. FOGARTY VENOUS EMBOLECTOMY CATHETER, 10 CC BALLOON Complete Collapse Nil 0 Lung collapse score Bronchial Blockers vs. Left DLTs Left-Thoracotomy/VATS 0 Min. 10 Min. 20 Min. Arndt Cohen Fuji DLT Narayanaswamy M, et al. Anesth Analg 2009, 108: Number of repositions Bronchial Blockers vs. Left DLTs Left-Thoracotomy/VATS (n= 26/ group) Arndt Cohen Fuji DLT Narayanaswamy M, et al. Anesth Analg 2009, 108: New Bronchial Blockers Elliptical Arndt Blockers Spherical COHEN FUJI ARNDT Volumen 32, Suplemento 1, abril-junio 2009 S221
3 INDICATIONS FOR LUNG ISOLATION Absolute: Blood Pus Air Devices for lung isolation used by anesthesiologists with limited thoracic experience. Relative: Surgical Exposure Surgical Exposure Lung Protection Blood Pus Fluid Ventilation BPF ILV THE ABC S OF LUNG ISOLATION Anatomy Bronchoscope Chest X-ray, CT Scan Campos JH, et al. Anesthesiology 2006;104:261-6 «the most critical factor in successful placement was the anesthesiologists knowledge of endoscopic bronchial anatomy» RIGHT LUNG LEFT LUNG 19 Upper lobe Apical Posterior Apical posterior Upper Lobe Middle lobe Lateral Medial Lateral Superior Medial Posterior Lower lobe Superior Posterior Lower lobe 9 Superior Inferior Lateral Lingula S222
4 LEFT DOUBLE-LUMEN TUBES Clinical experience with 1,170 patients Positioning of DLTs with auscultation and observation of chest wall movement «The authors find bronchoscopy unnecessary in the majority of patients and do not use it routinely» Brodsky JB, Lemmens HJM. JCVAnesth 2003;17: SINGLE -VS. DOUBLE-LUMEN TUBES IN CROSS-SECTION SUGGESTED SIZES FOR DOUBLE-LUMEN TUBES Sex Height Size of tube (Fr) Female < 160 cm (63 in) 35 Female 160 cm 37 Male < 170 cm (67 in) 39 Male 170 cm Fr Fr Right thoracotomy Left thoracotomy Volumen 32, Suplemento 1, abril-junio 2009 S223
5 ANESTHESIA FOR ACUTE BRONCHO-PLEURAL FISTULA Goals: Protect healthy lung Avoid tension pneumothorax Ensure adequate ventilation 70 y.o. female, day 7, post right pneumonectomy Airway management: Single-, double-lumen, BB Intubation: Awake, spont. vent., rapid sequence S224
6 ESTE DOCUMENTO ES ELABORADO POR MEDIGRA- PHIC 62 Y.O. MALE, LEFT LOWER LOBE LUNG CANCER, PREVIOUS FAILED INTUBATION AWAKE FIBEROPTIC DOUBLE-LUMEN INTUBATION Volumen 32, Suplemento 1, abril-junio 2009 S225
7 Glidescope VIDEO LARYNGOSCOPE + AIRWAY EXCHANGE CATHETER THE STRUCTURE SEEN IN THE CIRCLE IS? A. Right intermedius B. Left upper lobe C. Left mainstem D. Right middle lobe E. Right upper lobe S226
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