Sun Lan,Zhang Jianmin,Cui Xiaohuan,et al.Comparison of two placement methods of Arndt endobronchial blocker in pediatric patients undergoing thoracic surgery[J].Journal of Clinical Pediatric Surgery,,19():935-938.[doi:10.3969/j.issn.1671-6353.2020.10.014]
Comparison of two placement methods of Arndt endobronchial blocker in pediatric patients undergoing thoracic surgery
- Keywords:
- Intubation; Intratracheal; Thoracic Surgical Procedures; Child
- CLC:
- R655;R616.5
- Abstract:
- Objective To compare the efficiency of intraluminal versus extraluminal approach on placing 5 French Arndt endobronchial blocker (AEB) during one-lung ventilation and seek an optimal placement method of AEB in pediatric thoracic patients.Methods Sixty children aged 3-8 years scheduled for thoracic operations were randomized into two groups of intraluminal placement of 5F AEB (intraluminal,n=30) and extraluminal placement of 5F AEB (extraluminal,n=30).Two groups received endotracheal intubation and AEB implantation after anesthesia induction.The durations for endotracheal tube and AEB placement and time for fiber bronchoscope position were recorded.The relevant perioperative parameters were measured including end-tidal carbon dioxide partial pressure (PETCO2) and peak airway pressure (Ppeak) during two/one-lung ventilation.Intraoperative lung collapsed score,endobronchial exfoliation and hypoxia were recorded and the frequency of postoperative hoarseness was observed.Results PETCO2 and Ppeak were significantly higher in both groups during one-lung ventilation than that during double-lung ventilation (P<0.05).Ppeak of intraluminal group was significantly higher than that of extraluminal group during one-lung ventilation (P<0.05).The durations for AEB placement and fiber bronchoscope position were shorter in extraluminal group than those in intraluminal group (P<0.05).Conclusion As compared with intraluminal approach,extraluminal approach has less adverse impact on ventilatiory parameters and it is easier to locate by fiberoptic bronchoscopy.
References:
1 刘国亮,张建敏.Arndt支气管内阻断器和双腔支气管导管在小儿单肺通气中的比较[J].首都医科大学学报,2017,38(3):361-364.DOI:10.3969/j.issn.1006-7795.2017.03.007. Liu GL,Zhang JM.Comparison of the effect of Arndt endobronchial blocker and double-lumen tube on one-lung ventilation in children[J].Journal of Capital Medical University,2017,38(3):361-364.DOI:10.3969/j.issn.1006-7795.2017.03.007.
2 Templeton TW,Downard MG,Simpson CR,et al.Bending the rules:a novel approach to placement and retrospective experience with the 5 French Arndt endobronchial blocker in children<2 years[J].Paediatr Anaesth,2016,26(5):512-520.DOI:10.1111/pan.12882.
3 Mourisse J,Liesveld J,Verhagen A,et al.Efficiency,efficacy,and safety of EZ-blocker compared with left-sided double-lumen tube for one-lung ventilation[J].Anesthesiology,2013,118(3):550-561.DOI:10.1097/ALN.0b013e3182834f2d.
4 肖婷,屈双权.小儿单肺通气技术新进展[J].临床小儿外科杂志,2016,15(6):625-628.DOI:10.3969/j.issn.1671-6353.2016.06.027. Xiao T,Qu SQ.Technique advances of one-lung ventilation in children[J].J Clin Ped Sur,2016,15(6):625-628.DOI:10.3969/j.issn.1671-6353.2016.06.027.
5 Templeton TW,Morris BN,Goenaga-Diaz EJ,et al.A prospective comparison of intraluminal and extraluminal placement of the 9-French Arndt bronchial blocker in adult thoracic surgery patients[J].J Cardiothorac Vasc Anesth,2017,31(4):1335-1340.DOI:10.1053/j.jvca.2017.02.188.
6 Shafy SZ,Hakim M,Kamata M,et al.Intracuff pressure during one-lung ventilation in infants and children[J].J Pediatr Surg,2019,54(9):1929-1932.DOI:10.1016/j.jpedsurg.2018.10.110.
7 Templeton TW,Templeton LB,Lawrence AE,et al.An initial experience with an Extraluminal EZ-Blocker?:A new alternative for 1-lung ventilation in pediatric patients[J].Paediatr Anaesth,2018,28(4):347-351.DOI:10.1111/pan.13342.
8 Liang P,Ni J,Zhou C,et al.Efficacy of a new blind insertion technique of Arndt endobronchial blocker for lung isolation:comparison with conventional bronchoscope-guided insertion technique-a pilot study[J].Medicine (Baltimore),2016,95(19):e3687.DOI:10.1097/MD.0000000000003687.
9 Mohtar S,Hui TWC,Irwin MG.Anesthetic management of thoracoscopic resection of lung lesions in small children[J].Paediatr Anaesth,2018,28(11):1035-1042.DOI:10.1111/pan.13502.
10 乔南南,潘阳阳,苏涛,等.支气管封堵器外置法单肺通气在小儿肺包虫手术麻醉中的应用一例[J].临床小儿外科杂志,2019,18(12):1084-1085.DOI:10.3969/j.issn.1671-6353.2019.12.020. Qiao NN,Pan YY,Su T,et al.Application of external bronchial occlusion for pediatric lung hydatid surgery during single-lung ventilation:one case report[J].J Clin Ped Sur,2019,18(12):1084-1085.DOI:10.3969/j.issn.1671-6353.2019.12.020.
Memo
收稿日期:2019-09-20。
通讯作者:张建敏,Email:zjm428@sina.com