Letters to the Editor: Letters & Announcements
We appreciate Dr. Garcia-Guasch’s comments regarding our case report (1). Hypoventilation is generally not a problem because the endotracheal tube is connected to the ventilator during placement of the Arndt bronchial blocker. Tightening the collar around the blocker catheter can minimize the gas leak. Furthermore, increasing fresh gas flows helps to counterbalance the small leak in most patients. In our patient, ETco2 and Paco2 were within normal limits throughout the case.
The use of an exchange catheter to facilitate double lumen tube placement is a well-known, established technique for patients with difficult airways. However, it is not always successful and requires the removal of an existing proven and protected airway (the single-lumen endotracheal tube). In our patient with burn scar contractures and esophageal reflux disease in whom we had already had difficulty advancing a double-lumen tube, we opted not to take the additional chance of losing the airway or subject the patient to additional laryngoscopies when the option of the bronchial blocker existed.
W. C. Culp, Jr., MD
Department of Anesthesiology, Scott & White Memorial Hospital, The Texas A&M University Health Science Center College of Medicine, Temple, TX, firstname.lastname@example.org
Michael P. Kinsky, MD
Department of Anesthesiology, The University of Texas Medical Branch at Galveston, Galveston, TX
1. Culp WC Jr, Kinsky MP. Sequential one-lung isolation using a double Arndt bronchial blocker technique. Anesth Analg 2004;99:945-6.