Con: A Bronchial Blocker Is Not a Substitute for a Double-Lumen Endobronchial Tube

THE MODERN PRACTICE of thoracic surgery depends on the ability of the anesthesiologist to dependably isolate and selectively ventilate the patient’s lungs. By doing so, the clinician can provide both a collapsed lung and quiet operative field for the surgeon while also protecting the healthy lung from cross-contamination. In adults, these goals are achieved by either endobronchial intubation with a double-lumen tube (DLT) or by obstructing a bronchus with a bronchial blocker (BB). There are certain clinical situations in which one of these lung isolation techniques may be superior to the other (Table 1). For most thoracic procedures, however, either method can be used safely. The majority of anesthesiologists, when surveyed, continue to prefer a DLT in their routine practice. 1 Shelley B. Macfie A. Kinsella J. Anesthesia for thoracic surgery: A survey of UK practice. J Cardiothorac Vasc Anesth. 2011; 25: 1014-1017 Abstract Full Text Full Text PDF PubMed Scopus (65) Google Scholar , 2 Della Rocca G. Langiano N. Barosselli A. et al. Survey of thoracic anesthetic practice in Italy. J Cardiothorac Vasc Anesth. 2013; 27: 1321-1329 Abstract Full Text Full Text PDF PubMed Scopus (35) Google Scholar The author believes there are good reasons for that choice. Table 1Lung Isolation Techniques Favors Double-Lumen Tube (DLT) Favors Bronchial Blocker (BB) •Quicker and easier to place ○“Blind” placement possible if fiberscope not available •More rapid lung deflation •Intraoperative tube displacement less frequent •Allows bronchoscopic examination of operated lung during surgery •CPAP easily applied •Allows suctioning before re-inflation of operative lung •Allows operative lung to be safely re-expanded and collapsed as often as needed during procedure •Single tube can be used for sequential surgery to both lungs during same procedure •Can be used for operations on either ipsilateral and/or contralateral lung if main bronchus obstructed •Only technique for bronchopulmonary lavage •Allows “split-lung” ventilation in ICU •Placed through or alongside an endotracheal tube or LMA ○Patients with “difficult” airway when DLT difficult or impossible to use ○Can be placed through oral, nasal, or tracheostomy tubes ○Useful for patients with in situ endotracheal tube ○Advantage when tube exchange considered dangerous □Patients requiring postoperative ventilation •Ventilation through multiport adaptor can continue during BB placement •Less potential for airway trauma •Allows selective lobar isolation •Children too small for a DLT Abbreviations: BB, bronchial blocker; CPAP, continuous positive airway pressure; DLT, double-lumen tube; LMA, laryngeal mask airway. Open table in a new tab Abbreviations: BB, bronchial blocker; CPAP, continuous positive airway pressure; DLT, double-lumen tube; LMA, laryngeal mask airway.