Submitted by: Submitted by virenkalsekar
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Pages: 16
Category: Science and Technology
Date Submitted: 02/17/2013 08:01 AM
Double-lumen endotracheal tube for one-lung
ventilation through a fresh tracheostomy
stoma: A case report
Lana Leinbach Yaney, CRNA, MS, BSN
South Weymouth, Massachusetts
For one-lung ventilation in many surgical cases, doublelumen endotracheal tubes are the first-line choice for airway
management. For most cases, double-lumen endotracheal
tubes are faster, easier to place, cheaper, and less prone to
malposition than today’s bronchial blocker devices.
This report describes an elective tracheostomy and the
use of a double-lumen endotracheal tube directly through
the fresh stoma site for a 55-year-old man with a known difficult airway who had undergone a left-sided radical neck
dissection and postoperative radiation 10 years earlier. The
11-hour operation, in supine and lateral positions, occurred
uneventfully. This report documents one-lung ventilation of
a 4-hour duration using a double-lumen endotracheal tube
directly through a fresh tracheostomy site without supple-
T
his report involves a unique case of successful one-lung ventilation of a 4-hour duration
using a conventional double-lumen endotracheal tube (DL-ETT) electively placed
directly through a fresh stoma site in a
patient with abnormal upper airway anatomy. This
type of airway management is unusual, and there is
limited information in the anesthesia literature to support its use. Other alternative airways for patients
with a known difficult intubation and the requirement
of one-lung ventilation for maximum surgical exposure are described. The Univent (Vitaid, Ltd, Toronto,
Ontario, Canada) and Arndt blockers (Cook Medical
Inc, Bloomington, Indiana) have been used in patients
with existing tracheostomies who require one-lung
ventilation. These bronchial blockers will be explored
as potential options for optimal airway management
as related to this particular case.
Case summary
A 55-year-old man, ASA physical status III, with a
known history of difficult airway...