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J Thorac Cardiovasc Surg 1997;114:300
© 1997 Mosby, Inc.

LETTERS TO THE EDITOR

Technique for one-lung ventilation during video-assisted thoracoscopic surgical interruption of patent ductus arteriosus in children

B.M. Birla Heart Research Centre
1/1, National Library Ave.
Calcutta, 700 027, India

To the Editor:

Subsequent to the initial half dozen cases of patent ductus arteriosus (PDA) done with the use of video-assisted thoracoscopic surgery (VATS), we have modified the technique of one-lung ventilation for VATS. We now achieve right-sided one-lung ventilation by intubating the right main-stem bronchus. Right main-stem bronchial intubation is performed by insertion of a single-lumen endotracheal tube with left-facing bevel (with the tip of the endotracheal tube to the right of center) deep into the tracheobronchial tree. This results in right main-stem intubation in 100% of cases. After induction of anesthesia and endotracheal intubation, bilateral air entry is checked and the single-lumen endotracheal tube is advanced deeply and then withdrawn slowly until breath sounds are heard all over the right hemithorax and no breath sounds on the left hemithorax. The length of the endotracheal tube needed to achieve this single lung ventilation is noted on the external surface of the tube, and then the tube is withdrawn further to maintain double lung ventilation during positioning and draping of the patient. Once thoracostomies are performed for VATS, one-lung ventilation is achieved by inserting the endotracheal tube to a distance noted previously. By means of this technique, the left lung is totally unventilated and collapsed to the entire satisfaction of the anesthetic and surgical team. During one-lung ventilation, the inspired oxygen fraction is increased to 100%, tidal volume reduced by 20%, and respiratory rate increased by 20%. The monitoring includes electrocardiogram, direct arterial pressure, central venous pressure, pulse oximetry, end-tidal carbon dioxide analysis, and blood gas analysis. This method of one-lung ventilation is simple (no extra equipment/bronchoscopy is required) and safe (no risk of slippage of the blocker).

We have used this technique of right main-stem intubation for VATS during operations for PDA in 45 children, ages ranging from 6 months to 9 years (mean 3.6 years) and weights ranging from 8 to 27 kg (mean 15.7 kg). Now we are routinely performing PDA clipping through VATS using right main-stem bronchial intubation and have abandoned the new technique of one-lung ventilation described by Vakamudi and associates ¹ in favor of right main-stem bronchial intubation for obvious reasons.

12/8/82677

References

1. Vakamudi M, Shenoy V, Halder J, et al. A new technique for one-lung ventilation during video-assisted thoracoscopic surgical interruption of patent ductus arteriosus in children. J Thorac Cardiovasc Surg 1995;110:273-4.[Free Full Text]
   

This Article Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Muralidhar, K. Articles by Prasad, S. D. Search for Related Content PubMed PubMed Citation Articles by Muralidhar, K. Articles by Prasad, S. D.