M. Yavuz GÜRSOY, Emine ÇAPAR, Çimen OLGUNER

Çocuk olguda Fogarty kateteriyle tek akciğer ventilasyonu

Tek akciğer ventilasyonu (TAV) erişkin olgularda genellikle çift lümenli endo-bronşiyal tüple (ÇLET) gerçekleştirilir. Çocuklarda ise yaşlarına uygun ÇLET olmaması nedeniyle TAV için alternatif teknikler kullanılmaktadır. TAV, 6 yaşından küçük çocuklarda selektif endobronşiyal entübasyon veya bir endobronşiyal blokemi yardımıyla uygulanmaktadır. Bu yazıda, sağ akciğerdeki kist hidatik nedeniyle torakotomi yapılması planlanan 4 yaşındaki çocuk olguda başarıyla uygulanan alternatif tek akciğer ventilasyonu tekniğinin sunulması amaçlanmıştır. Standart monitorizasyon ve genel anestezi indüksiyonunu takiben, iç çapı 5,0 mm kafsız endotrakeal tüple (ETT) intübasyon gerçekleştirildi. Fiberoptik görüntü eşliğinde 4 Fr Fogarty embolektomi kateteri ETT içinden geçirilerek sağ akciğer ana bronşuna ilerletildi. İşlem sırasında hipoksemi gelişmeden TAV başarıyla uygulandı. Postoperatif seyir sorunsuzdu ve hasta operasyonun 8. günü evine taburcu edildi. Sonuç olarak, bu yöntemin tek akciğer ventilasyonu için yeterli ekipmanın bulunmadığı 4-6 yaş grubu çocuk olgularda, basit ve etkin bir şekilde uygulanabilen farklı bir seçenek olabileceği kanısına varılmıştır.

Anahtar Kelimeler:

Kateterizasyon, Çocuk, okul öncesi, Kadın, Entübasyon, intratrakeal, Akciğer, Ventilatörler, mekanik, Pulmoner ventilasyon, Ultrasonografi, Tedavi sonucu

One-lung ventilation with a Fogarty catheter in a child patient

One-lung ventilation (OLV) is generally achieved by double-lumen endotracheal tube (DLT) in adults. However, alternative techniques are used for OLV because of the absence of the suitable DLTs in the pediatric population. OLV can be achieved by selective endobronchial intubation alone or with the insertion of a endobrochial blocker in pediatric patients smaller than six years of age. We aimed in this report, a successful one-lung ventilation by using an alternative technique in a four years'old girl weighing 16 kg with right lung cyst hydatics who is undergoing thoracotomy. Following standard monitorization and general anesthesia induction, conventional endotracheal intubation was performed with internal diameter 5.0 mm uncuffed endotracheal tube (ETT). 4 Fr Fogarty embolectomy catheter was advanced as an endobronchial blocker (EBB) into that right lung main bronchus through the ETT under fiberoptic visual guidance. OLV was successfully achieved without hypoxemia during blocker placement. The post-operative course was uneventful, and patient was discharged home on the 8th postoperative day. In conclusion, we suggest that, if there is no available adequate equipment, this method can be easily and effectively used as an different alternative for one-lung ventilation in children of 4 -6 years of age.

Keywords:

Catheterization, Child, Preschool, Female, Intubation, Intratracheal, Lung, Ventilators, Mechanical, Pulmonary Ventilation, Ultrasonography, Treatment Outcome,

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1. Haynes SR, Bonner S. Anaesthesia for thoracic surgery in children. Paediatr Anaesth 2000; 10:237-251.
2. Hammer GB. Single-lung ventilation in infants and children. Paediatr Anaesth 2004;l4:98-102.
3. Benumof JL, Partridge BL, Salvatierra C, Keating J. Margin of safety in positioning modern double-lumen endotracheal tubes. Anesthesiology 1987;67:729-738.
4. Kamaya H, Krishna PR. New endotracheal tube (Univent tube) for selective blockade of one lung. Anesthesiology 1985;63:342-343.
5. Hammer GB, Fitzmaurice BG, Brodsky JB. Methods for single-lung ventilation in pediatric patients. Anesth Analg 1999;89:1426-1429.
6. Patrick DA, Rothenberg SS. Thoracoscopic resection of mediastinal masses in infants and children: an evaluation of technique and results. J Pediatr Surg 2001;36:1165-1167.
7. Yun ES, Saulys A, Popic PM, Arndt GA. Single-lung ventilation in a pediatric patient using a pediatric fibreoptically-directed wire-guided endobronchial blocker. Can J Anaesth 2002;49:256-261.
8. McCartney CJ, Johnston G. Anaesthetic management of a 6-week-old child with unilateral pulmonary interstitial emphysema. Paediatr Anaesth 2000;l0:325-328.
9. Tobias JD. Thoracic surgery in children. Curr Opin Anaesth 2001;14:77-85.
10. Hammer GB, Manos SJ, Smith BM, Skarsgard ED, Brodsky JB. Single-lung ventilation in pediatric patients. Anesthesiology 1996;84:1503-1506.
11. Ginsberg RJ. New technique for one-lung anesthesia using an endobronchial blocker. J Thorac Cardiovasc Surgl981;82:542-546.
12. Wald SH, Mahajan A, Kaplan MB, Atkinson JB. Experience with the Arndt paediatric bronchial blocker. Br J Anaesth 2005;1:92-94.
13. Camci E, Tuğrul M, Turnaoglu S, Senturk M, Akpir K. Techniques and complication of one-lung ventilation in children with suppurative lung disease: experience in 15 cases. J Cardiothorac Vase Anesth 2001;15:341-345.
14. Hammer GB, Harrison TK, Vricella LA, Black MD. Krane EJ. Single lung ventilation in children using a new paediatric bronchial blocker. Paediatr Anaesth 2002;12:69-72.
15. Use T, Shimamoto H, Fukano T, Sumikawa K. Single lung ventilation in a pediatric patient using a Fogarty catheter with a hollow center. Masui. 2004;53:69-71.