Bronchial blockers are inflatable devices that are passes through a single lumen tube to selectively occlude a bronchial orifice. First used by Sir Ivan Magill.
CHARACTERISTICS:-
- Balloon shaped to stabilize it in bronchus.
- Low pressure and high volume balloon preferred.
- Flexible and easy to manipulate into main stem /lobar branches
- Balloon to have channel for deflation and suction distal to it
- Be adaptable to use standard ETT.
- Wide variety of sizes available.
TYPES:-
- UNIVENT
- ARNDNT
- COHENS FLEXITIP
- FUJI UNIBLOCKER
- E- Z BLOCKER
A 29-year-old female came with compliant of cough with expectoration on and off for past 2 years.. It is gradual in onset, sputum is whitish in colour, not blood tinged..
Associated with fever on & off. H/o weight loss +around 6 kg. No other significant history..
No known comorbidites
Ct chest showed – left lower intralobar sequestration with infective pathology
Preoperative routine investigations were done. All are within normal limits…
Spirometry showed FEV1/FVC = 70 %.. Mild obstruction present
Abg @ Room air done. Pao2 = 88 mm hg, pc02 = 31 mm hg
Airway examination :
- Mouth opening > 3 finger breath
- Mallampatti grade 2
- Normal neck movements
After preoperatively optimised, patient was posted for ROBOTIC LEFT LOWER LOBE LOBECTOMY
For this case, we are used EZ blocker for one lung ventilation.
EZ BLOCKER :
- It is an independent bronchial blocker with a y shaped bifurcation made up of polyurethane.
- Available in 7 Fr size and is 75 cm long.
- It is manufactured with a Y shaped distal end
- Both limbs of the distal end are fitted with : An inflatable balloon & central channel to allow suction.
- Each limb is colour coded. (Yellow /Blue ). This allow easy identification with the matching balloon.
DLT AND BRONCIAL BLOCKER (ADVANTAGES)
DLT AND BRONCHIAL BLOCKER
(DISADVANTAGES) USES:-
- Difficult airways
- Limited mouth opening – Nasotracheal intubation
- Already intubated patient requiring lung isolation
- Tracheostomy patient
- Selective lobar blockade
- Patient with distorted bronchial anatomy
- Paediatric patient
- Potential for mechanical ventilation in the postoperative period.
Dr. KARTHICK RAJA
Consultant of Anaesthesia
Kauvery hospital, Chennai.
Dr. B. VARALAKSHMY
3rd year DNB Anaesthesia Resident
Kauvery hospital, Chennai.