Successful one-lung ventilation by blocking the right intermediate bronchus in a 7-year-old child: a case report

Our plain-English summary of Successful one-lung ventilation by blocking the right intermediate bronchus in a 7-year-old child: a case report, by S.Y. Baek, J.H. Kim, G. Kim, et al (The Journal of International Medical Research, 2019).

The study

• Authors: S.Y. Baek, J.H. Kim, G. Kim, J.H. Choi, C.Y. Jeong, K.H. Ryu, D.H. Park
• Journal: The Journal of International Medical Research
• Published: 2019;47(6):2740-2745
• Type of article: Case report
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

A 7-year-old child underwent surgical excision of a benign mesothelioma of the pleura near the right lower lung. Although insertion of a wire-reinforced endotracheal tube through the left main bronchus was attempted for one-lung ventilation to secure the surgical field of view, the attempt failed. Therefore, an endotracheal tube was inserted into the trachea, and an Arndt endobronchial blocker (Cook Medical, Bloomington, IN, USA) was placed in the right intermediate bronchus under bronchoscopic guidance to selectively block the right lower and middle lobes. The surgery was performed while ventilating the right upper lobe and left lung, and no specific intraoperative adverse events occurred.

In plain English

This case report from Eulji University Medical Center in Daejeon, Korea, describes the anesthesia used for one child's chest surgery. It does not discuss asbestos or any other cause of the tumor. A 7-year-old girl had right chest pain when coughing. She was diagnosed with a benign mesothelioma of the pleura, which CT scanning showed as a lesion of about 4 cm near the 7th to 9th right ribs. For the operation, doctors needed to ventilate only part of her lungs. They first tried to place a breathing tube into her left main bronchus, but this failed. They then placed a tube in the trachea and used a bronchoscope to guide an Arndt endobronchial blocker into the right intermediate bronchus. This blocked the right middle and lower lobes while the right upper lobe and left lung kept breathing. No adverse events occurred during surgery. A fast heart rate during wake-up was treated with esmolol. The authors concluded that this selective blocking can be a good technique for one-lung ventilation in children.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (single patient)
• Who was studied: One 7-year-old girl (124 cm, 26 kg) with a benign mesothelioma of the pleura, treated at Eulji University Medical Center, Daejeon, Korea; date of treatment not stated
• Exposure: No asbestos or other environmental or occupational exposure is reported. The article concerns an anesthesia technique (an Arndt endobronchial blocker placed in the right intermediate bronchus) for surgical removal of the tumor.
• Main results:
  • The attempt to place a one-lumen endotracheal tube into the child's left main bronchus failed. The authors attributed this to the angle of the bronchus.
  • A 7.0 Fr, 65 cm Arndt endobronchial blocker was placed under bronchoscopic guidance in the right intermediate bronchus.
  • No adverse events occurred during the operation in this patient.
  • During emergence from anesthesia the child had a heart rate above 160 beats/min, which was treated with 7 mg of intravenous esmolol.
  • After about 1 hour of monitoring in the recovery room, the child showed no abnormalities and was transferred to the general ward.
• The authors' conclusion: The authors concluded that selectively isolating the right middle and lower lobes can be a good technique for one-lung ventilation in children.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Bronchus, Mesothelioma, Pleura.

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