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Selective Lobar Exclusion in Robot-Assisted-Thoracic Surgery Using EZ Blocker

Published:April 04, 2022DOI:https://doi.org/10.1053/j.jvca.2022.03.036
      LUNG EXCLUSION AND ONE-LUNG VENTILATION are the standard for the management of thoracic parenchymal surgery, usually achieved with bronchial blockers (BB) or, more frequently, with double lumen endobronchial tubes (DLT), as recently highlighted by Langiano et al
      • Langiano N
      • Fiorelli S
      • Deana C
      • et al.
      Airway management in anesthesia for thoracic surgery: A “real life” observational study.
      and Clayton-Smith et al
      • Clayton-Smith A
      • Bennett K
      • Alston RP
      • et al.
      A comparison of the efficacy and adverse effects of double-lumen endobronchial tubes and bronchial blockers in thoracic surgery: A systematic review and meta-analysis of randomized controlled trials.
      . However, there are situations, as in the case of patients with difficult airways, tracheostomy, or prolonged mechanical ventilation after surgery, in which the use of endobronchial blockers could be the best viable option.
      • Moritz A
      • Irouschek A
      • Birkholz T
      • et al.
      The EZ-blocker for one-lung ventilation in patients undergoing thoracic surgery: Clinical applications and experience in 100 cases in a routine clinical setting.
      A critical scenario in which bronchial blockers may be preferred to a DLT is a cancer patient who has undergone previous contralateral pulmonary resection. In such a case, a selective lobar blockade, providing highly selective lung segment ventilation, may be warranted and is not feasible with a DLT. Among the blockers, the EZ-Blocker (EZB, Teleflex Life Sciences Ltd., Ireland), recently introduced on the market, characterized by a Y-shaped design and differently colored inflatable low-volume high pressure cuffs at each distal end, makes lung isolation possible.

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