Usage of EZ blocker on bilateral videothoracoscopic sympathectomy
Senior
Editor;
Videothoracoscopic sympathectomy is used for several
vasomotor diseases , the most common and successful field of application is
hyperhidrosis.
Videothoracoscopic sympathectomy is a minimal
invasive procedure with low risk of complication. It needs a short while of
time and patients dont need to be hospitalized.These benefits let the
physicians practice safely.
Unilateral lung ventilation (ULV) is mandatory for
accomplishing the procedure in a short while.
. Double
lumen endotracheal tube (DLET) is generally used for Endotracheal intubation.
Usage of DLETs cause some disadvantages. Bronchoscopy is
commonly needed for proper placement of the tube. . DLETs are thicker then the
normal tubes, placement of the tubes are extra hard for patients with difficult
airway.Indeed
postoperative tracheal rupture and hoarseness cases are more common. . DLETs also may need to be replaced with
single lumen tubes for patients who need postoperative intubation. .On
some operations like bilateral thoracoscopic smypathectomy , both lungs need to
be deflated in turns. technical problems like tube changes during the operation
show up and lengthen the operation time. Bronchial blockers ,used for
the same purpose are placed with single lumen tubes.Broncoscopy is again needed
for the correction of the placement. .
Despite its disadvantages ,bronchial blockers present similar
performance comparing DLETs.
. EZ
bloker (®) (EZ; AnaesthetIQ BV, Rotterdam, Hollanda), has been started to get
used lately.
.It
provides bilateral lung ventilation without any additional manipulation.
).
It has two extensions sitting on the trakeal bifurcation which lets you deflate
the desired lung by inflating its cuff . (Figure 1) It can be placed through a single lumen endotracheal tube.
Bronchoscope may be needed for verification of placement.
EZ blocker may only be used to
block the mainstem bronchus and to achieve a total lung collaps. There is a chance
that two extensions might stick together and enter in the same mainstem brochus
which can be determined easily. Unlike the bronchial blocker selective block of
a lobe is not possible.
. EZ blocker can be placed by physician blindly
when needed by an emergency case, saving alot of time.
.It is also
provides quite simplicity and comfort when both lungs need to be inflated and deflated
in turns.
Vegh T. and his friends have used
EZ bloker on 10 patients who need SLV
They have
underlined the usage of EZ blocker on difficult intubation cases and emergency
surgery because of the shortened time of placement and fast deflation of lung.
Maurisse J. And her
friends have compared DLET and EZ blocker on 100 patients who need SLV.
They have measured
the placement time of the EZ blocker longer.
Besides sore throat
and horseness are found to be fewer among the EZ blocked patients.
Ruetzler K. And his
friends have compared EZ blocker and DLET on 40 patients who need SLV.
Although measuring
the Placement time of EZ blocker longer ,
there hasnt been noticed any differences about lung deflation quality and
bronchoscopy results.
We have used EZ
blocker on 14 patients who had thoracoscopic
sympathectomy operation for hyperhidrosis.In all the cases the placement was
verified with bronchoscopy.Successfull SLV was performed during entire operation.
Average Duration of
placement for the Ez blocker is 5,1±3,7 minutes.The
device has maintained its position within position change.Reentubation hasnt
been neccessary when the deflated lung
was changed.
Deflated lung transition
was performed only with a simple inflated cuff change.
No hoarseness or
sore throat was seen postoperatively.
We have made our
mind to declare that EZ blocker has performed SLV perfectly and it is the most
appropriate device for the operations with single lung deflation such as
throcoscopic sympathectomy.
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