Cruz Patricia, Orozco Hugo David, Garutti Martinez Ignacio, Hernández Fernández Gloria
Hospital General Universitario Gregorio Marañón, Departamento de Anestesiología, Madrid, Espanha.
Clínica Los Nogales, Departamento de Anestesiología, Bogota, Colômbia.
Braz J Anesthesiol. 2018 Mar-Apr;68(2):200-204. doi: 10.1016/j.bjan.2017.04.004. Epub 2017 May 16.
In recent years, laser resection of lung metastases has been established as the standard procedure worldwide. To avoid airway fire, it is necessary to collapse the surgical lung. The selective lobar bronchial blockade is a technique that allows one-lung ventilation while the operated lobe is collapsed in patients with previous pulmonary resection requiring subsequent resection or with limited pulmonary reserve. We report a clinical case about our experience of a selective lobar bronchial blockade technique with a bronchial blocker (Coopdech endobronchial blocker) that was employed successfully with a double-lumen endotracheal tube in a patient with previous contralateral pulmonary resection who was scheduled for atypical resections of pulmonary metastases by laser. We selectively blocked the right intermediate bronchus for management of hypoxemia during one-lung ventilation. This technique provided adequate ventilation and oxygenation during surgery, avoiding the need of two-lung ventilation during lung metastases resection by laser.
This case shows that if a properly positioned double-lumen tube was already in place and the patient does not tolerate one-lung ventilation because of hypoxemia, it would be possible to provide selective lobar blockade by placing a bronchial blocker through the lumen of the double-lumen tube, avoiding the use of continuous positive airway pressure during laser surgery. This technique does not disturb the operative field or interrupt the operative procedure during resection by laser, which would occur during two-lung ventilation or used of continuous positive airway pressure.
近年来，肺转移瘤的激光切除术已成为全球标准手术。为避免气道着火，有必要使手术侧肺萎陷。选择性肺叶支气管封堵术是一种在既往有肺切除术需后续手术或肺储备有限的患者中，在手术肺叶萎陷时实现单肺通气的技术。我们报告了一例临床病例，介绍了我们使用支气管封堵器（Coopdech 支气管内封堵器）进行选择性肺叶支气管封堵术的经验，该封堵器与双腔气管导管一起成功应用于一名既往有对侧肺切除术、计划行肺转移瘤非典型激光切除术的患者。我们在单肺通气期间选择性封堵右中间支气管以处理低氧血症。该技术在手术期间提供了足够的通气和氧合，避免了激光切除肺转移瘤时进行双肺通气的需要。
该病例表明，如果已正确放置双腔气管导管，且患者因低氧血症不能耐受单肺通气，则可通过经双腔气管导管腔置入支气管封堵器来实现选择性肺叶封堵，避免在激光手术期间使用持续气道正压通气。该技术在激光切除过程中不会干扰手术视野或中断手术操作，而双肺通气或使用持续气道正压通气时则会出现这种情况。
