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Totaltrack videolaryngoscope and VivaSight SL with bronchial blockers insertion whitout using fiberscope. A new way to isolate the lung

      Introduction

      Lung isolation is a frequent requirement when performing thoracic surgery. This can be achieved with a double-lumen endotracheal tube (DLT) or a variety of bronchial blockers (BBs). Traditionally DLT has been considered the gold standard; however there is an increasing number of patients where its use is not feasible: difficult airway, patients with a tracheostomy, the need for selective lobe isolation and if postoperative intubation is required. In these situations, the BBs have their main role. These devices are placed in the main or lobar bronchi through single orotracheal tubes (OT), using the fiberoptic bronchoscope as a guide or through OT with a built-in optical camera.(1)

      Case report

      62-y-old male patient, ASA II, proposed for a right inferior lobectomy due to a malignant tumour. Airway evaluation was significant with an enlarge neck diameter, limited neck movement and Mallampati III. Due to the presence of these difficult airway predictors, the use of BB for lung isolation was preferred and TotalTrack VLM® was used for ventilation and intubation. As an alternative to the fiberscope we decided to use a VivaSight SL™ for BB placement through direct vision in the right main bronchi.
      In this case a combination of TotalTrack VLM®, VivaSight SL™ 7.5 mm and a BB Uniblocker™ was used. Right lung collapse was achieved with success and the surgery was uneventfull.

      Discussion

      Airway management is a paramount area in anesthesia. In a difficult airway situation, the presence of a device that allows ventilation and intubation with continuous vision through all the process is the key in the management of patients with low pulmonary reserve, as are many of the candidates for pulmonary resection surgery. This can be achieved through a novel video laryngeal mask called TotalTrack VLM®.
      Moreover, lung collapse is essential in thoracic anesthesia. The use of the fiberoptic bronchoscope is the gold standard to verify the correct position of the DLT or the BB, and is of vital importance in the last one.
      When the fiberscope is not available or when we need an alternative, the tube VivaSight SL™ can be used. This is a single lumen OT with a built-in camera that allows the confirmation of the correct position of the BB and a continuous vision of the airway with the possibility for immediate correction if a displacement of the BB occurs(2).
      The combine use of the TotalTrack VLM® with the VivaSight SL™ allows excellent management of the airway when the fiberscope is not available.

      REFERENCES

      1. Kreft T, Zardo P, Busk H, Kretzschmar M, Kozian A, Schilling T. Modern Bronchial Blockers in Thoracic Surgery. Curr Anesthesiol Rep Springer US; 2016;6(2):103–10.
      2. Associate AS, Associate KTS. VivaSight : a new era in the evolution of tracheal tubes. J Clin Anesth. Elsevier Inc.; 2016;33:442–9.