Letters to the Editor: Letters & Announcements
To the Editor:
Recent advances in thoracic surgery have resulted in a greater need for single-lung ventilation in children. For smaller children, the Fogarty embolectomy catheter (Edwards Lifescience, Irvine, CA; Arrow International, Reading, PA) or Arndt blocker (Cook Critical Care, Bloomington, IN) are frequently used as a bronchial blocker. Conventional bronchial blocker insertion alongside an endotracheal tube can cause hypoxemia during the placement of a blocker and may be difficult to reposition should the blocker be displaced. Recently, adaptors have been used to facilitate administration of oxygen and ventilation during blocker insertion through an indwelling tracheal tube (1,2). However, a double-access-port endotracheal tube is cumbersome to prepare and relatively large to handle for small children. Although an Arndt multiport adaptor is easy to use, the smallest size Arndt adaptor is 5F and might be too large for patients <2 yr of age.
For single-lung ventilation in small pediatric patients, we have fabricated a simple multiport adaptor made with readily available materials.
An elbow connector with a hole for ETco2 monitoring is prepared. A small side hole is made at the right-angle side of the prepared elbow connector and insert the tip of a 1-mL syringe using an epoxy adhesive. After the glue hardens, the small side hole is capped with the rubber piston of the 1-mL syringe and the other hole initially for ETco2 is capped with the rubber piston from a 2-mL syringe. After piercing each rubber cap with an awl, a Fogarty catheter is inserted through the small side port and the fiberoptic bronchoscope is inserted through the other port (Fig. 1). To facilitate insertion, lubrication is helpful.
This adaptor can provide independent access for ventilation, blocker insertion, and the fiberoptic scope. In addition, 3F or 4F Fogarty catheters can be inserted without leakage. Using this adaptor, ventilation can be performed during blocker positioning especially in small children, including infants. Although the Fogarty catheter can facilitate one-lung ventilation in children, its high balloon pressure can cause damage to the bronchus. One-lung ventilation should therefore be performed cautiously and the balloon inflated to just that required.
Jin-Tae Kim, MD, PhD
Tae-Gyoon Yoon, MD, PhD
Hee-Soo Kim, MD, PhD
Chong-Sung Kim, MD, PhD
Seong-Deok Kim, MD, PhD
Department of Anesthesiology and Pain Medicine
Seoul National University Hospital, Seoul National University College of Medicine
1. Takahashi M, Horinouchi T, Kato M, Hashimoto Y. Double-access-port endotracheal tube for selective lung ventilation in pediatric patients. Anesthesiology 2000;93:308–9
2. Arndt GA, DeLessio ST, Kranner PW, Orzepowski W, Ceranski B, Valtysson B. One-lung ventilation when intubation is difficult—presentation of a new endobronchial blocker. Acta Anaesthesiol Scand 1999;43:356–8