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Update on selective lobar blockade during pulmonary resections.

Javier H Campos1

  • 1Department of Anesthesia, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA. javier-campos@uiowa.edu

Current Opinion in Anaesthesiology
|March 20, 2009
PubMed
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Selective lobar blockade offers advantages for thoracic surgery patients with prior lung resections. This technique improves oxygenation by avoiding complete lung collapse during procedures.

Area of Science:

  • Thoracic Surgery
  • Anesthesiology
  • Pulmonary Medicine

Background:

  • Patients undergoing thoracic surgery with a history of lobectomy or pneumonectomy often have limited pulmonary reserve.
  • Complete lung collapse in these patients can lead to significant hypoxemia and surgical complications.
  • Previous lung resections necessitate careful consideration of lung isolation techniques.

Purpose of the Study:

  • To review the benefits of selective lobar blockade in patients with prior contralateral lung resections.
  • To highlight selective lobar blockade as an alternative to complete lung collapse in thoracic surgery.
  • To discuss methods and considerations for selective lobar blockade in complex thoracic cases.

Main Methods:

  • Selective lobar blockade using a bronchial blocker or a double-lumen endotracheal tube.

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  • Fiberoptic bronchoscopy is essential for accurate placement of lung isolation devices, especially after bronchial resection.
  • Focus on isolating only the target lobe(s) for surgical intervention.

    • Main Results:

    • Selective lobar blockade allows for adequate surgical exposure while maintaining ventilation in non-surgical lung areas.
    • This technique significantly improves intraoperative oxygenation in patients with compromised respiratory function.
    • It avoids the detrimental effects of complete lung collapse on oxygenation.

    Conclusions:

    • Selective lobar blockade is a viable and advantageous technique for thoracic surgery in patients with previous lung resections.
    • It provides a safer alternative to total lung collapse, enhancing patient outcomes.
    • Meticulous attention to tracheobronchial anatomy via bronchoscopy is crucial for successful implementation.