Pro: Bronchial Blockers Should Be Used Routinely for Providing One-Lung Ventilation

NE-LUNG VENTILATION (OLV) traditionally has been provided with the use of a double-lumen tube (DLT). The use of bronchial blockers (BBs) to provide lung isolation has grown in recent years. Despite the development of BBs specifically designed for lung separation, the DLT has remained the preferred technique for providing lung isolation. A recent survey in the United Kingdom revealed a 98% preference rate for the DLT, 1 and 64% of respondents reported rarely using a BB to provide lung isolation. A number of arguments have been advanced to support the notion that a DLT is superior to a BB and should be used routinely for providing OLV. In reality, some of these arguments are myths while others are valid, as will be presented in the discussion below. The specific features of the individual BBs in current use may impact the relative utility of using one of these devices, and it is worthwhile to briefly describe each of them here. The first commercially manufactured device with a BB for lung isolation was the Univent Tube (Fuji Systems, Tokyo, Japan), and it currently remains available. The Univent tube contains a single lumen for ventilation and a channel that houses the BB. The tube is relatively bulky for the size of its ventilating lumen due to the presence of the BB channel. For this reason, and with the advent of newer BBs, which are passed through an in situ endotracheal tube, the Univent tube has fallen out of favor, and the author would recommend against its use. The BBs, which currently receive the greatest usage, are the Arndt Endobronchial Blocker (Cook, Bloomington, IN), the Cohen Flexi-tip (Cook, Bloomington, IN), and the Uniblocker (Fuji Systems, Tokyo, Japan). These 3 blockers have varying designs and insertion techniques, which give the practitioner different options. The Arndt blocker has a lumen through which there passes a wire that exits in a loop, beyond its distal end. The fiberscope is passed through this loop and is advanced into the mainstem bronchus, with the BB trailing. The wire snare is loosened, and then is removed once the BB is in good position. The position of the BB then is checked as the fiberscope is withdrawn. The Arndt blocker is somewhat cumbersome to use, with multiple steps needed for proper placement. Released following the introduction of the Arndt blocker, the Cohen Flexi-tip has a wheel at the operator end that, when turned, flexes the tip towards an arrow that is inscribed near the tip of the blocker. Advancement of the BB is observed via a fiberscope, which also is passed through a multiport connector. The most newly released of these three blockers, the Uniblocker, is the simplest in design and usage: the BB has a bent tip and comes preinserted through a multiport connector. It is simply turned towards the side to be blocked and advanced under direct vision with the fiberoptic bronchoscope. Familiarity easily can be achieved with a minimum of training, obviating the need for use of a more complex BB system. The Uniblocker can be a viable option for those with limited thoracic anesthesia experience, and placement actually may be easier than a DLT, so the author recommends its use. It is also significantly less expensive than the Arndt and Cohen blockers although still more costly than a DLT.