Lung separation and the difficult airway

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Presentation transcript:

Lung separation and the difficult airway J.B. Brodsky British Journal of Anaesthesia Volume 103, Pages i66-i75 (December 2009) DOI: 10.1093/bja/aep262 Copyright © 2009 British Journal of Anaesthesia Terms and Conditions

Fig 1 The ‘margin of safety’, defined as the length of the tracheobronchial tree over which a tube can be moved or positioned without obstructing a conducting airway, is very small when a TT is used to isolate the lungs. (a) Advancing the tube until its cuff is entirely within the bronchus will cause the tip of the tube or the cuff to obstruct the bronchial orifice to the upper lobe. (b) Withdrawing the tube until the upper lobe is no longer obstructed will place the cuff in the trachea where it will no longer isolate the healthy lung. British Journal of Anaesthesia 2009 103, i66-i75DOI: (10.1093/bja/aep262) Copyright © 2009 British Journal of Anaesthesia Terms and Conditions

Fig 2 Algorithm for difficult airway management when lung separation is required. British Journal of Anaesthesia 2009 103, i66-i75DOI: (10.1093/bja/aep262) Copyright © 2009 British Journal of Anaesthesia Terms and Conditions

Fig 3 (a) A patient with an extremely small tracheal stoma required lung separation. (b) After preoxygenation and induction of anaesthesia, a paediatric FOB and a BB were placed directly through the stoma and the blocker was positioned in the bronchus. (c) The bronchoscope was then removed, the balloon of the bronchial blocker was inflated, and a small TT was inserted through the tracheostomy stoma to ventilate the patient. British Journal of Anaesthesia 2009 103, i66-i75DOI: (10.1093/bja/aep262) Copyright © 2009 British Journal of Anaesthesia Terms and Conditions

Fig 4 For a patient with a tracheostomy, lung separation can be obtained with a BB through a TT or tracheostomy tube directly in the stoma, with a conventional DLT (a) or with a short DLT intended for tracheostomies (b). British Journal of Anaesthesia 2009 103, i66-i75DOI: (10.1093/bja/aep262) Copyright © 2009 British Journal of Anaesthesia Terms and Conditions

Fig 5 Airway control at completion of surgery for patients requiring postoperative mechanical ventilation. British Journal of Anaesthesia 2009 103, i66-i75DOI: (10.1093/bja/aep262) Copyright © 2009 British Journal of Anaesthesia Terms and Conditions