电视胸腔镜手术(VATS)期间的单肺通气(OLV)可以通过几种不同的技术来完成,包括气管内导管(ETT)的支气管推进,使用双腔管(DLT),或放置支气管内阻滞剂。在大多数情况下,DLT是在心胸手术期间隔离和通气单个肺的主要手段。在其他技术上部署DLT的原因包括易于放置,减少错位的机会,快速放置时间,和肺部放气的质量。然而,该病例报告强调了支气管阻滞剂在双腔导管无法通气的患者中的重要性。简而言之,这名年轻女性患者的右胸肿块伴有同侧肺塌陷和中度胸腔积液。计划进行CT引导活检,但放射科医生推迟了,因为病人无法俯卧。然后将该病例转诊给心胸外科医生,他计划对病灶进行右VATS和活检。在手术室,麻醉诱导后,患者无法通过DLT进行通气,并且遇到了高峰值的气道压力。最初,使用了37号的左侧DLT,随后,还尝试了35、32和28号,但是所有这些为病人换气的尝试都是徒劳的。做了支气管镜检查,没有显示任何异常的气道。由于无法用双腔管给患者通气,手术被推迟。在重复CT扫描并在一周内排出9.3升胸腔积液后,患者再次被安排进行相同的手术,但改变了麻醉计划.这一次,使用支气管阻滞剂隔离右肺,麻醉计划成功实施。手术继续进行,患者术后时间平稳。该患者的麻醉管理提出了一系列独特的挑战,在此案例报告中共享。
One-lung ventilation (OLV) during video-assisted thoracoscopic surgery (VATS) can be accomplished through several different techniques, including bronchial advancement of an endotracheal tube (ETT), use of a double-lumen tube (DLT), or placement of an endobronchial blocker. In most cases, a DLT is a mainstay of isolating and ventilating a single lung during cardiothoracic procedures. The reasons to deploy a DLT over other techniques include ease of placement, less chance of malposition, quick placement time, and quality of lung deflation. However, this
case report highlights the importance of a bronchial blocker in a patient where a double-lumen tube failed to ventilate the lungs. Briefly, this young female patient had a right thoracic mass associated with ipsilateral lung collapse and moderate pleural effusion. CT-guided biopsy was planned but was deferred by the radiologist, as the patient was unable to lie in a prone position. The
case was then referred to the cardiothoracic surgeon who planned a right VATS and biopsy of the lesion. In the operation theater, after induction of anesthesia, the patient could not be ventilated through a DLT, and high peak airway pressures were encountered. Initially, a size 37 left-sided DLT was used, and subsequently, sizes 35, 32, and 28 were also tried, but all these attempts to ventilate the patient remained futile. A bronchoscopy was done, which did not show any abnormality in the airway. The surgery was postponed due to an inability to ventilate the patient with a double-lumen tube. After a repeat CT scan and draining of 9.3 liters of pleural effusion over a week, the patient was again scheduled for the same procedure but with a changed anesthetic plan. This time around, the anesthetic plan was implemented successfully using a bronchial blocker to isolate the right lung. The surgery went ahead, and the patient had an uneventful postoperative period. The anesthetic management of this patient presented a unique set of challenges, which are shared in this
case report.