Background

The use of video-assisted thoracoscopic surgery (VATS) has increased in the past decade in adults as well as children. Single lung ventilation (SLV) is desirable during VATS and is used frequently also during open thoracotomy.

Older methods for SLV are of limited use in very young children (endobronchial blocker with Fogarty catheter, endobronchial intubation). Double lumen endotracheal tube is suitable only for children from 8 years of age. Arndt Endobronchial Blocker (AEB) is used successfully for lung isolation in younger children. The smallest 5 French (Fr) AEB requires 4,5mm internal diameter (ID) of endotracheal tube (ET) to accommodate AEB and the smallest fibreoptic bronchoscope (FOB) endoluminally. Therefore, it’s use is limited to children older than 2 years.

Method

Retrospective analysis included 63 children that underwent thoracic procedures, between January 2013 and December 2015. Among that 28 (44%) cases were VATS procedures, that needed SLV.

Results

AEB was used in 60 (95%) of cases, double lumen ET in 3 (5%) of cases. Endobronchial intubation was not used. The quality of lung deflation was satisfactory in all the cases. Malposition and dislodgement of AEB and occurred but it was successfully repositioned in lateral position.

We also report our experience with placing the 5 Fr AEB outside the ET (extraluminal) in 1 very young child (<1 year old).

Conclusion

The use of AEB and double lumen ET tube provides excellent conditions for VATS as well as for open thoracotomy procedures in children of all ages.

 

Špela Pirtovšek Štupnik, dr.med., Jelena Berger, dr.med.
UKC Ljubljana, Clinical Department for Anesthesiology, Ljubljana, Slovenia

Corresponding presenting author's contact:
Špela Pirtovšek Štupnik
UKC Ljubljana, Slovenia
e-mail: spela.stupnik@kclj.si
Phone: 0038631257757

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