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• W2000673025 abstract "Videothoracoscopic thoracic sympathectomy is used for several vasomotor diseases; the most common and successful use of this application is for hyperhidrosis. Videothoracoscopic sympathectomy is a minimally invasive procedure with a low risk of complications. This operation can be performed in a short time, and patients usually do not need to be hospitalized more than a few hours. These benefits let the physicians practice safely.1Krasna M.J. Thoracoscopic sympathectomy: A standardized approach to therapy for hyperhidrosis.Ann Thorac Surg. 2008; 85: 764-767Abstract Full Text Full Text PDF Scopus (37) Google Scholar Although thoracoscopic sympathectomy can be performed under an apneic period, single-lung ventilation (SLV) is necessary for short operation times and a comfortable operation, generally by using a double-lumen endotracheal tube (DLET).1Krasna M.J. Thoracoscopic sympathectomy: A standardized approach to therapy for hyperhidrosis.Ann Thorac Surg. 2008; 85: 764-767Abstract Full Text Full Text PDF Scopus (37) Google Scholar There are some disadvantages of these DLETs. Fiberoptic bronchoscopy (FOB) commonly is needed for a proper placement of the endotracheal tube. DLETs are thicker than the normal endotracheal tubes, so replacement of these tubes is hard in patients with difficult airways. Postoperative hoarseness and tracheal rupture are known complications.2Zhong T. Wang W. Chen J. et al.Sore throat or hoarse voice with bronchial blockers or double-lumen tubes for lung isolation: A randomised, prospective trial.Anaesth Intensive Care. 2009; 37: 441-446PubMed Google Scholar DLETs can be replaced with single-lumen tubes in patients who may need postoperative mechanical ventilation in intensive care units. Sequential SLV can be needed during some bilateral operations such as thoracoscopic sympathectomy. During these operations, both lungs need to be ventilated in turn. Technical problems like displacement of the endotracheal tube while repositioning the patient for the other side extends the operative time. Fiberoptic bronchoscopy is needed for correct placement of bronchial blockers that can be used for the same reason with single-lumen endotracheal tubes. These bronchial blockers have some disadvantages like high-pressure cuffs and displacements. Bronchial blockers have similar performance compared to DLETs despite their disadvantages.3Campos J.H. Which device should be considered the best for lung isolation: Double-lumen endotracheal tube versus bronchial blockers.Curr Opin Anaesthesiol. 2007; 20: 27-31Crossref PubMed Scopus (131) Google Scholar EZ-blocker (®) (EZ; AnaesthetIQ BV, Rotterdam, Netherlands) (Figure) has been used for SLV in the last few years. It provides bilateral lung ventilation separately without any additional manipulation. It has 2 extensions sitting on the tracheal bifurcation that permits deflating the desired lung by inflating its cuff (Figure). It can be placed through a single-lumen endotracheal tube. Fiberoptic bronchoscopy may be needed for verification of placement. However, it is possible that the 2 extensions may stick together and enter the same mainstem bronchus. EZ-blocker may only be used to block the mainstem bronchus and to achieve a total lung collapse, so selective block of a single lung lobe is not possible with EZ-blocker. EZ-blocker can be placed by a physician blindly in case of an emergency if it is necessary and saves time.4Mungroop H.E. Wai P.T. Morei M.N. et al.Lung isolation with a new Y-shaped endobronchial blocking device, the EZ-Blocker.Br J Anaesth. 2010; 104: 119-120Crossref PubMed Scopus (35) Google Scholar It also provides simplicity and comfort when both lungs need to be inflated and deflated in turns. Vegh et al have used EZ-blocker on 10 patients who have needed SLV.5Végh T. Juhász M. Enyedi A. et al.Clinical experience with a new endobronchial blocker: The EZ-blocker.J Anesth. 2012; 26: 375-380Crossref PubMed Scopus (14) Google Scholar They have underlined the usage of EZ-blocker on difficult intubation cases and emergency surgery because of the shortened time of placement and fast deflation of the lung. Mourisse et al have compared DLET and EZ-blocker on 100 patients for SLV. They found that the placement of the EZ-blocker time was longer. Besides, sore throat and hoarseness were found to be fewer among the EZ-blocked patients.6Mourisse J. Liesveld J. Verhagen A. et al.Efficiency, efficacy, and safety of EZ-blocker compared with left-sided double-lumen tube for one-lung ventilation.Anesthesiology. 2013; 118: 550-561Crossref PubMed Scopus (90) Google Scholar Ruetzler et al have compared EZ-blocker and DLET on 40 patients for SLV.7Ruetzler K. Grubhofer G. Schmid W. et al.Randomized clinical trial comparing double-lumen tube and EZ-Blocker for single-lung ventilation.J Anaesth. 2011; 106: 896-902Crossref PubMed Scopus (65) Google Scholar Although placement of EZ-blocker time was longer, there was no difference in confirmation with fiberoptic bronchoscopy and quality of deflation. The authors have used EZ-blockers in 14 patients who had thoracoscopic sympathectomy for regional hyperhidrosis. All placements of the EZ-blockers were verified with fiberoptic bronchoscopy. Successful SLV was performed during the entire duration of the operations. The average time of placement for the EZ-blocker was 5.1±3.7 minutes. The device has maintained its position during patient position change. There was no need to reintubate for the other side. When it is done for the first lung ventilation, the other lung deflation is performed just by changing the inflated cuff. No hoarseness or sore throat was seen postoperatively. The authors think that EZ-blocker is easy to use and is the most appropriate device for these operations with single-lung deflation such as thoracoscopic sympathectomy." @default.
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• W2000673025 title "Usage of EZ-blocker on Bilateral Videothoracoscopic Sympathectomy" @default.
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