Emily A. Covington Outline Definition Indications Contraindications Technique & Specifications Perioperative Considerations Postoperative Complications The University of Kansas Hospital One Lung Ventilation
Alternative to two-lung ventilation Separates right and left lungs Provided per surgeon request
Absolute Indications
Required for procedure Prevention of contamination Control of distribution Unilateral bronchopulmonary lavage Relative Indications
Not required for procedure Surgical exposure Unilateral pulmonary embolectomy Contraindications
Patient refusal Airway mass Rapid Sequence Intubation Difficult Airway
Technique
Double-lumen endotracheal tube Endotracheal lumen
Endobronchial lumen
Endotracheal Cuff Endobronchial Cuff Double Lumen Tube (Ibrahim, n.d.) Types & Specifications Carlens White Bryce Smith Robertshaw Lumen Hook + + - - Side
Left Right Left & Right Left & Right (Ibrahim, n.d.) Sizing Height
Tube size Male > 170 cm 170 cm 41 F 39 F Female > 160 cm 160 cm 37 F 35 F (OLeary & Duthie, n.d.) Complications
Hoarseness Airway Obstruction Vocal cord lesions Ipsilateral Damage Bilateral paralysis Obstruction vs. Hoarseness (Herman, 2002) Vocal Cord Lesions Carinal Hook (Ibrahim, n.d.) Approach at KU Hospital
Left-sided Mallinckrodt DLT Robertshaw design
NO carinal hook Fiberoptic confirmation Mallinckrodt DLT Bronchial limb Tracheal limb Radio-opaque marking (Covidien, 2012) Questions? References Covidien. (2012). Specialty endotracheal airways. Retrieved from http://www.covidien.com/rms/pages.aspx?page=OurBrands/Mallinckrodt Herman, C. (2002). Medialization thyroplasty for unilateral vocal cord paralysis. AORN Journal, 75(3), 512-522. doi:10.1016 S0001- 2092(06)61173-3 Ibrahim, A. (n.d.). One lung ventilation [PowerPoint Slides]. Retrieved from telemed.shams.edu.eg/moodle/pluginfile.php Levine W. C. (Ed.). (2010). Clinical anesthesia procedures of Massachusetts General Hospital (8th ed.). Philadelphia, PA: Lippincott Williams & Wilkins. Neustein, S. M., Eisenkraft, J. B., & Cohen, E. (2009). Anesthesia for thoracic surgery. In P. Barash, B. Cullen, R. Stoelting, M. Cahalan, & M. Stock (Eds.), Clinical anesthesia (6 th ed., pp. 1032-1072). Philadelphia, PA: Lippincott Williams & Wilkins. OLeary, R. & Duthie, D. (n.d.). Double lumen endobronchial tube sizes in routine practice [PowerPoint Slides]. Retrieved from www.ctsymposium2012.com/Abstracts/Duthie%20DLT%20size.pptx Rieker, M. (2010). Anesthesia for thoracic surgery. In J. Nagelhout & K. Plaus (Eds.), Nurse anesthesia (4 th ed., pp. 630-650). St. Louis, MO: Saunders. Tugrul, M., Camci, E., Karadentz, H., Senturk, M., Pembect, K., & Akptr, K. (1997). Comparison of volume controlled with pressure controlled ventilation during one-lung anaesthesia. British Journal of Anaesthesia, 79, 306-310. Retrieved from http://bja.oxfordjournals.org/content/79/3/306.full.pdf