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Single-lung ventilation in a pediatric patient using a pediatric fibreoptically-directed wire-guided endobronchial blocker

[La ventilation unilatérale chez un patient pédiatrique à l'aide d'un bloqueur endobronchique muni d'une tige métallique pour guidage fibroscopique]

From the Department of Anesthesiology University of Wisconsin Hospital and Clinics, Madison, Wisconsin, USA.

Dr. Elizabeth S. Yun, Department of Anesthesiology, U.W., Clinical Sciences Center B6/319 Clinical Sciences Center, 600 Highland Avenue, Madison, WI 53792-3272, USA. Phone: 608-263-5447; Fax: 608-263-0575; E-mail: esyun{at}facstaff.wisc.edu

Purpose: The pediatric wire-guided endobronchial blocker is a new device for single-lung ventilation through small diameter endotracheal tubes. In this case report we will discuss the use of this blocker in a pediatric patient.

Clinical features: We successfully placed the pediatric wire-guided endobronchial blocker in a 14-yr-old patient who underwent an aortic coarctation repair. The blocker is a 5-French 70 cm double-lumen catheter. One lumen contains an adjustable wire loop. The other lumen inflates a spherical low pressure, high volume balloon. Through a special bronchoscopy port, the blocker and bronchoscope were placed into a 7.0 cuffed endotracheal tube, the bronchoscope passed through the wire loop of the blocker and advanced towards the left mainstem bronchus. Then the blocker was advanced over the bronchoscope and positioned in the left mainstem bronchus. The balloon was slowly inflated under direct vision and the bronchoscope removed. During the case, single lung ventilation was achieved by inflating the balloon, thus collapsing the lung. At the end of the case, the lung was reinflated by deflating the balloon and the blocker was removed without difficulty. The patient tolerated the procedure well and had an uneventful postoperative course.

Conclusion: Because of the endobronchial blocker's small diameter, this device can be used in a small endotracheal tube without sacrificing the inner diameter (ID) cross sectional area. Therefore, the patient is ventilated through a conventional endotracheal tube with a larger ID compared to the ID of a double-lumen endotracheal tube.

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