July 2005 - The Hong Kong College of Anaesthesiologists

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Bull HK Coll Anaesthesiol Volume 14, Number 2 July 2005to its anatomy and the proximity of the rightupper lobe bronchus to the carina.As a result of these anatomicalconsiderations and his labile oxygenation, it wasnot possible to subject the patient to protractedmanipulations using a bronchial blocker. A rightsided DLT would be inappropriate since it isdesigned with the intention of avoidingocclusion of the right upper lobe, by having anorifice in the bronchial cuff.Some of the potential problems with ourtechnique of using a left sided DLT to achieveright endobronchial intubation is kinking of thetube with increase in airway pressures. This canbe avoided during insertion by ensuring that theDLT is inserted with the major convexity facingthe intubator, such that the preformed leftcurvature now faces the right of the patient.Although this patient did not demonstrate anyincrease in airway resistence 6 as demonstratedby the airway pressure remaining the same aswhen using a single lumen tracheal tube, this isstill a theoretical possibility especially if thecurvature of the DLT is straightened.The method reported above for isolation ofthe right upper lobe bronchus of this patientoffers an effective approach to management of apatient with right upper lobe bulla, in the face oflabile oxygenation status. Since mostanesthetists are familiar with DLT placement,this technique has the advantage of beingexpeditiously performed, avoiding protractedmanipulation inherent in other techniques inpatients with labile arterial oxygenation.References1. Schulte am Esch J, Keiser ER, Horstmann R.The indication for the use of anendobronchial double lumen tube in theintensive care of unilateral pulmonarycomplications. Anaesthetist 1982;8:400‐7.2. Powner DJ, Eross B, Grenvik A. Differentiallung ventilation with PEEP in treatment ofunilateral pneumonia. Crit Care Med1977:31:170‐2.3. Nazari S, Trazzi R, Moncalvo F, et al. A newmethod for separate lung ventilation. JThoracic Cardiovasc Surg 1988;95:133‐8.4. Chen KP, Chan HC, Huang SJ. FoleyCatheter used as bronchial blocker for onelung ventilation in a patient with atracheostomy. Acta Anaesthesiol Sin199533:41‐4.5. Slinger PD. Fibreoptic bronchoscopicpositioning of double‐lumen tubes. JCardiothorac Anesth 1989;4:486‐96.6. Hammond JE, Wright DJ. Comparison of theresistences of double‐lumen endobronchialtubes. Br J Anaesth 1984;56:299‐302.7. Caseby NG. Anaesthesia for the patient withcoincidental giant lung bulla: a case report.Can Anaesth Soc J 1981;3:272‐6.8. Otruba Z, Oxorn D. Lobar bronchialblockade in bronchopleural fistula. Can JAnaesth 1992;39:176‐8.9. Joel A. Kaplan (Ed.) Thoracic Anaesthesia,Second Edition, Churchill Livingstone 1991.105
Bull HK Coll Anaesthesiol Volume 14, Number 2 July 2005WORKSHOPS ORGANISED BY THE INSTITUTE OF CLINICAL SIMULATIONA Collaboration between the Hong Kong College of Anaesthesiologists and the North District Hospital(Application form can be downloaded from the College website: www.hkca.edu.hk)Anaesthetic Crisis Resource Management (ACRM)Date: First Saturday of each month ‐ slots available from March 2005(3 September, 10 September, 5 November and 3 December, 2005)Time: 08:00 – 18:00Venue:The Institute of Clinical SimulationCME points:HKCA 10 pointsMax participants: 4Fee:HK$2000 per headFormat:Each registrant will participate in(1) An introduction on the METI Simulator, the anesthetic machine for use in theworkshop and the theories of crisis management(2) Allocated time for hands‐on crisis scenario management on the METI Simulator,rotating through different roles and handling different scenarios(3) A group debriefing session at completion of each scenario“Group” registration welcome if you can find your own partners to form a group of four. Mutually agreed datesmay be arranged. Sessions will be videotaped. All participants in the workshop will be required to sign aconfidentiality statement.Difficult and Advanced Airway Management (DAAM) WorkshopTime: 22 October 2005Venue:Institute of Clinical SimulationCME points: HKCA 4.5 pointsMax participants: 16Fee:HK$1,200 per headObjectives:(a) Recognition of patients with potential difficult airway or impossible tracheal intubation(b) Practice of Airway Algorithm on situations of failure to oxygenate patients(c) Description and application of suitable ventilatory techniques to oxygenate patients with predicted andunpredicted difficult airways.Programme:(1) Lectures on basic knowledge of airway management(2) Videotapes on different techniques of recent and advance airways(3) Tutorial discussion on common causes of airway problem(4) Skill stations on various techniques(5) MCQ and OSCE assessment after the courseHighlights of interesting techniques and skill stations:(1) Virtual bronchoscopy training on computer model(2) Practice bronchoscopy on pig’s lung(3) Different gadgets on one‐lung ventilation in difficult situations (Univent, Arndt’s wire‐guided endobronchialblocker)(4) Bullard laryngoscope workstation(5) Cricothyrotmy sets and techniques106
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July 2005 - The Hong Kong College of Anaesthesiologists

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