Fluoroscopic Guided Extraluminal Placement of Pediatric Endobronchial Blocker for Lung Isolation for Thoracotomy in a Small Child: A Case Report

Naba Mateen Madoo,
satish K kulkarni,
Vaibhavi Baxi*

Abstract

Abstract: One lung ventilation (OLV) is essential for adequate visualization and surgical exposure for thoracic surgeries. It is challenging in small children due to limited choice of instruments and anatomical and physiological differences of airway from adults. Patient concerns: A 4 year old male child (weight: 12 kg, height: 95cm) presented with fever with chills and breathing difficulty since one month. Diagnosis: Contrast enhanced computed tomography (CECT) revealed loculated pleural collection in left upper lobe with suspicion of empyema with two cavitatory lesions with air fluid level in the left upper lobe. Interventions: Child was scheduled for left thoracotomy. To ensure successful OLV we used microcuff endotracheal tube (ETT) with paediatric bronchial blocker placed extraluminally and parallel to ETT during laryngoscopy. The final endobronchial placement; due to unavailability of smaller diameter fibreoptic bronchoscope of bronchial blocker, was done by injecting a diluted iodinated dye in the bronchial blocker (BB) lumen under fluoroscopic guidance. Outcomes: We performed successful OLV using microcuff ETT and paediatric bronchial blocker placed under fluoroscopic guidance. The surgery was completed with good lung isolation without any adverse events like hypoxemia or dislodgment. Conclusion: In case of unavailability of an appropriate sized FOB, lung isolation for thoracoscopic surgeries in small children can be done using fluoroscopic guided placement of paediatric bronchial blocker. In case the BB does not have a radio-opaque line/marker; an iodinated dye in small and diluted amount can be used to assist BB placement in main stem bronchus.