Reply to the Letter to the Editor on: Use of Bronchial Blockers for Single-Lung Ventilation in Infants and Children

The authors highly appreciate the comments on the recently published report on single- and double-lung ventilation for thoracoscopic lung resection in infants and children.[1]

In this Letter to the Editor, the author suggests the use of bronchial blockers as an alternative to mainstem intubation and Univent or double lumen tubes for single-lung ventilation in children.

We completely agree that there are different practicable ways of performing lung isolation—along with advantages and disadvantages.

Mainstem intubation seems to be the most practicable alternative at a reasonable price, especially when using cuffed tubes without Murphy's eye.

Small bronchial blockers may be associated with difficulties of placement in some cases. In case the blocker accidentally recoils into the carina, the airway might be obstructed. Furthermore, overdistension of the balloon may damage the mucosa.

The 5 French Arndt blocker is much more cost-intensive compared with a cuffed single lumen tube for mainstem intubation. However, a major advantage of the Arndt blocker is a fine multiport adapter that simplifies simultaneous placement and ventilation while stabilizing the blocker's position.

Therefore, the use of Arndt blockers—as presented in the Letter to the Editor—is absolutely recommendable, especially when compared with Univent or double lumen tubes (with possibly higher cuff to mucosa pressure). An increasing number of recent publications report a safe and effective use of Arndt blockers in children and infants.[2] [3] [4] [5] [6]

• References

• 1 Dingemann C, Zoeller C, Bataineh Z, Osthaus A, Suempelmann R, Ure B. Single- and double-lung ventilation in infants and children undergoing thoracoscopic lung resection. Eur J Pediatr Surg 2013; 23 (1) 48-52
• 2 Sutton CJ, Naguib A, Puri S, Sprenker CJ, Camporesi EM. One-lung ventilation in infants and small children: blood gas values. J Anesth 2012; 26 (5) 670-674
• 3 Stephenson LL, Seefelder C. Routine extraluminal use of the 5F Arndt Endobronchial Blocker for one-lung ventilation in children up to 24 months of age. J Cardiothorac Vasc Anesth 2011; 25 (4) 683-686
• 4 Disma N, Mameli L, Pini-Prato A, Montobbio G. One lung ventilation with Arndt pediatric bronchial blocker for thoracoscopic surgery in children: a unicentric experience. Paediatr Anaesth 2011; 21 (4) 465-467
• 5 Marciniak B, Fayoux P, Hébrard A, Engelhardt T, Weinachter C, Horber RK. Fluoroscopic guidance of Arndt endobronchial blocker placement for single-lung ventilation in small children. Acta Anaesthesiol Scand 2008; 52 (7) 1003-1005
• 6 Bird GT, Hall M, Nel L, Davies E, Ross O. Effectiveness of Arndt endobronchial blockers in pediatric scoliosis surgery: a case series. Paediatr Anaesth 2007; 17 (3) 289-294