Salih TOPÇU, Emre SAHİLLİOĞLU, Mine SOLAK, Yavuz GÜRKAN, Kamil TOKER, Tülay HOŞTEN

Tek akciğer ventilasyonunda bronşiyal bloker deneyimlerimiz

Son zamanlarda torasik cerrahi tekniklerdeki ilerlemeler tek akciğer ventilasyonu tekniklerinin kullanımını artırmıştır. Tek akciğer ventilasyonu çift lümenli tüpler, fogarty kateterleri, Univent tüpler ve bronşiyal blokerlerle yapılır. Bu yazıda 15 göğüs cerrahisi vakasındaki bronşiyal bloker deneyimlerimiz sunulmuştur. 2007 yılı Ocak-Nisan aylarında torasik cerrahi sırasında tek akciğer ventilasyonu gerekli 15 hastaya bronşiyal bloker yerleştirildi. Bronşiyal blokerlerin tipi rastgele seçildi ve toplam 7 Arndt, 8 Cohen tipi bronşiyal bloker yerleştirildi. Endotrakeal entübasyonu takiben bazı hastalara yan, bazı hastalara ise sırtüstü pozisyonda bronşiyal bloker yerleştirildi. Yan pozisyon verildikten sonra hastaların hepsine fiberoptik inceleme yapıldı. On beş hastaya bronşiyal bloker yerleştirildi. Doğumsal trakeal bronküsü olan 1 hastada bronşiyal blokerle tek akciğer ventilasyonu sağlanamadı. Lateral pozisyondan sonra 2 hastanın bronşiyal blokerinin yer değiştirdiği görüldü ve tekrar pozisyon verildi. Her iki bronşiyal bloker tipi ile başarılı bir akciğer izolasyonu sağlandı. Hastanın hava yolu durumu, postoperatif dönemi ve cerrahinin türü göz önünde bulundurulduğunda bronşiyal blokerler tek akciğer ventilasyonunda alternatif bir hava yolu gereci olabilir.

Our bronchial blocker experiences in one lung ventilation

Recent advances in surgical techniques for thoracic have led to an increased use of one lung ventilation techniques. One lung ventilation is performed by doubled lumen tubes, fogarty catheters, Univent tubes and bronchial blockers. In this paper our bronchial blocker experiences were presented in fifteen thoracic surgery patients. Bronchial blockers were placed in fifteen patients who needed one-lung ventilation during thoracic surgery between January-April in 2007. Type of the bronchial blockers were selected randomly and total eight Cohen and seven Arndt bronchial blocker were placed. Following endotracheal intubation some of the bronchial blockers were performed at supine and the others were in lateral position to patients. Fiberoptic investigation was performed in all of the patients following lateral position. Bronchial blocker were placed in fifteen patients. In one patient who had congenital tracheal bronchus, one lung ventilation could not have been achieved by bronchial blocker. Following lateral positioning bronchial blocker of two patients were malpositioned and they were repositoned. Successfull one lung ventilation was performed by both bronchial blocker type. While the patient’s airway position, postoperative period and type of the surgery have been considered, bronchial blockers may be an alternative airway device for one-lung ventilation.

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