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  • Title: Selective left bronchial intubation and left-lung isolation in infants and toddlers: analysis of a new technique.
    Author: Chengod S, Chandrasekharan AP, Manoj P.
    Journal: J Cardiothorac Vasc Anesth; 2005 Oct; 19(5):636-41. PubMed ID: 16202899.
    Abstract:
    OBJECTIVES: The purpose of this study was to analyze and compare a new technique for left bronchial intubation and left-lung isolation in infants and toddlers without the help of bronchoscopes. METHODS: In this prospective, unique comparative study, 3 different techniques for left mainstem bronchus intubation and left-lung isolation using a Fogarty catheter as a bronchial blocker were conducted in 11 children under age 4 who required left-lung isolation for left-lung surgery. A new technique for Fogarty catheter insertion and balloon inflation for proper positioning and avoiding displacement during lung handling was used. The first technique was a blind introduction to the left bronchus of the endotracheal tube (ETT) with the head turned to the right and the tube turned to the left at 180 degrees . The second one was to introduce the preshaped Fogarty catheter to the left bronchus. The third one was to intubate the left bronchus using the new technique of a preshaped ETT. RESULTS: No left bronchial intubation could be achieved with the first technique. Left bronchial intubation and isolation were achieved in 2 of 11 by the second technique and 10 of 11 using the third technique. No bulb displacement occurred in any of these during lung handling. CONCLUSION: The new technique of left bronchial intubation with a preshaped endotracheal tube was simple, safe, and easily accomplished. A Fogarty catheter can be positioned properly without the aid of a smaller bronchoscope once the left bronchus is intubated. Balloon displacement can be avoided completely if the left lung is collapsed properly and completely before the final balloon inflation.
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