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Describe the use of single-lumen endotracheal tubes for one-lung ventilation.
Although one-lung ventilation using a single-lumen endotracheal tube is accomplished by advancing the tube into one of the mainstem bronchi, refinements of this tech-nique exist. A combined single-lumen endotracheal tube and bronchial blocker serve this purpose even better. The single-lumen tube is equipped with a narrow internal lumen through which a balloon-tipped bronchial blocker is advanced into the right or left mainstem bronchus. With the bronchial blocker retracted and deflated, the tube is positioned by standard techniques into the trachea. The tube is then turned 90° toward the side to be blocked, and the blocker is advanced blindly or under flexible fiberoptic bronchoscopic guidance into the appropriate bronchus. The balloon is inflated, and lung separation is confirmed by auscultation of breath sounds. This system provides a larger lumen for more efficient suctioning of blood and obviates the need for changing tubes at the completion of surgery for patients who require postoperative intubation and ventila-tion. Lung deflation through the small blocker lumen is time-consuming. More rapid collapse of the lung follows deflation of the blocker balloon and disconnection from the anesthesia breathing circuit to allow for lung deflation. After successful collapse, reinflation of the blocker balloon and connection to the anesthesia breathing circuit allows for ventilation of one lung and collapse of the other.
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