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Curr Opin Anaesthesiol. 2010 Feb;23(1):12-7. doi: 10.1097/ACO.0b013e328331e8a7.

Lung isolation techniques for patients with difficult airway.

Author information

  • Department of Anesthesia, University of Iowa Hospitals and Clinics, Iowa City, Iowa 52242, USA. javier-campos@uiowa.edu

Abstract

PURPOSE OF REVIEW:

One-lung ventilation in the thoracic surgical patient can be achieved with the use of a double-lumen endotracheal tube or an independent bronchial blocker. A number of patients requiring lung isolation have a potentially difficult airway because of previous radiation to the neck or previous surgery to the tongue and larynx. This review will focus on the management of patients who have a difficult airway and require lung isolation.

RECENT FINDINGS:

Identification of the potentially difficult airway during the preoperative evaluation allows the preplanning and selection of the appropriate lung isolation device. Common devices used to achieve one-lung ventilation in patients with difficult airways include independent bronchial blockers (Arndt, Cohen, and Fuji Uniblocker).

SUMMARY:

In patients who require one-lung ventilation and who present with a difficult airway, the safest way to establish an airway is by placing a single-lumen endotracheal tube orally or nasotracheally while the patient is awake with the aid of a flexible fiberoptic bronchoscope. Lung isolation in these patients then is achieved by using an independent bronchial blocker; an alternative technique is to use a double-lumen endotracheal tube while using an airway catheter exchange technique. For the patient with a tracheostomy in place, an independent bronchial blocker is recommended.

PMID:
19752725
[PubMed - indexed for MEDLINE]
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