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Modified technique for endobronchial blocker placement in pediatric patients undergoing thoracic surgery

Pediatric Anesthesia

Submitted December 2023 by Dr Shravya Karna

Read by 1263 Journal Watch subscribers

Despite one-lung ventilation providing optimised surgical conditions, positioning an extraluminal Arndt endobronchial blocker (AEBB) remains challenging particularly in children aged less than 6 years. Dislodgement and replacement is near impossible during surgery. The authors describe a novel technique described by Enk that allows for quick and effective placement and replacement using an angled wire.

1. The nylon loop is removed from a 5-French AEBB. The port is flushed with saline to decrease friction
2. The AEBB is passed through the vocal cords under direct laryngosopy followed by a half size smaller ETT next to it
3. Positioning of the AEBB is finalised after surgical positioning
4. An angled, half-J tip Terumo Glidewire (0.018 * 80cm) is placed into the AEBB such that the angled end protrudes past the distal end of the AEBB
5. A fibreoptic bronchoscope is passed through the ETT to visualise the wire above the carina
6. Roll the proximal end of the wire between the fingers, this will direct the distal angled tip
7. The AEBB is passed over the wire under and the balloon inflated under FOB visualization.
8. After securement, the wire can be removed to allow for lung deflation and suctioning.

The authors have successfully used this technique in over 50 infants and toddlers, including infants with bronchopulmonary sequestration, vascular ring and congenital pulmonary airway malformation.

Key Messages:
The Enk technique has been more successful than traditional methods for placement and replacement of AEBB, allowing for faster and safer OLV.

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