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Chapter 27 - Thoracic anaesthesia

from Section 3 - Specialties

Published online by Cambridge University Press:  10 January 2011

Ian Calder
Affiliation:
National Hospital for Neurology and Royal London Hospital
Adrian Pearce
Affiliation:
Guy's and St Thomas' Hospital, London
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Summary

A major component of safe thoracic anaesthesia is the appropriate use of endobronchial tubes, double-lumen tubes (DLTs) and bronchial blockers. A bronchial blocker is effectively a small balloon on a long catheter with a central lumen which, when placed endobronchially, occludes ventilation on that side and allows egress of gas from the isolated lung. Placement of DLT is awkward than a single lumen tube, and a difficult airway produces additional complexity. The introducer is a useful aid to intubation with single lumen tube by direct laryngoscopy but the normal introducer is too short to place a DLT in the same manner. The tube exchange catheters are supplied with rapi-fit connectors to allow low or high pressure ventilation in case of difficulty or desaturation during the tube exchange. Oral flexible fibreoptic intubation with DLT is a possible solution, and the fibrescope can be used to place it in the correct bronchus.
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Publisher: Cambridge University Press
Print publication year: 2010

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