Comparison of EZ blocker and left double-lumen endotracheal tube for one lung ventilation in minimally invasive cardiac surgery
Keywords:Minimally invasive cardiac surgery, Lung isolation, bronchial blocker, Double-lumen tube
Background/Aim: Effective lung isolation is required in minimally invasive cardiac surgery. Double lumen tubes (DLT) are most preferred for this type of operation, and data on the use of EZ blockers in cardiac surgery are limited. We aimed to compare the efficiency of the double lumen tube and EZ blockers in minimally invasive cardiac surgery with cardiopulmonary bypass performed through a right mini thoracotomy. Methods: A total of 89 patients who underwent minimally invasive cardiac surgery through right mini thoracotomy with cardiopulmonary bypass between January 1 and December 31, 2020, were included in this single-center, retrospective case control study. The group in which double lumen tubes were used for lung isolation (n = 58) was compared with that in which EZ blockers (n = 31) were used in terms of placement time, repositioning rate, lung collapse quality score, and postoperative sore throat and hoarseness. Results: The time needed to place the devices in the correct position was shorter in the DLT group (3.2 (2.7) min vs 4.6 (2.4) min, P=0.02). No significant difference was found between the prevalence of at least one repositioning and lung collapse quality scores (P=0.42, P=0.21). VAS scores for sore throat were lower and hoarseness was less encountered in the EZ blocker group (21.2 (8.8) vs 49.4 (7.6), P=0.01, 16.1% vs 48.2%, P=0.01, respectively). Conclusion: Although the EZ blocker has a longer placement time, it provides lung isolation as effective as DLT. Less sore throat and hoarseness show that EZ blocker is an important alternative for this type of surgery.
Iribarne A, Easterwood R, Chan EY, Yang J, Soni L, Russo MJ, et al. The golden age of minimally invasive cardiothoracic surgery: current and future perspectives. Future Cardiol. 2011 May;7(3):333-46. doi: 10.2217/fca.11.23.
Lamelas J, Sarria A, Santana O, Pineda AM, Lamas GA. Outcomes of minimally invasive valve surgery versus median sternotomy in patients age 75 years or greater. Ann Thorac Surg. 2011 Jan;91(1):79-84. doi: 10.1016/j.athoracsur.2010.09.019.
Brodsky JB. Con: a bronchial blocker is not a substitute for a double-lumen endobronchial tube. J Cardiothorac Vasc Anesth. 2015;29(1):237–239. doi: 10.1053/j.jvca.2014.07.027.
Neustein SM. The use of bronchial blockers for providing one-lung ventilation. J Cardiothorac Vasc Anesth. 2009 Dec;23(6):860-8. doi: 10.1053/j.jvca.2009.05.014.
Clayton-Smith A, Bennett K, Alston RP, Adams G, Brown G, Hawthorne T, et al. A Comparison of the Efficacy and Adverse Effects of Double-Lumen Endobronchial Tubes and Bronchial Blockers in Thoracic Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Trials. J Cardiothorac Vasc Anesth. 2015 Aug;29(4):955-66. doi: 10.1053/j.jvca.2014.11.017.
Ruetzler K, Grubhofer G, Schmid W, Papp D, Nabecker S, Hutschala D, et al. Randomized clinical trial comparing double-lumen tube and EZ-Blocker for single-lung ventilation. Br J Anaesth. 2011 Jun;106(6):896-902. doi: 10.1093/bja/aer086.
Lu Y, Dai W, Zong Z, Xiao Y, Wu D, Liu X, Chun Wong GT. Bronchial Blocker Versus Left Double-Lumen Endotracheal Tube for One-Lung Ventilation in Right Video-Assisted Thoracoscopic Surgery. J Cardiothorac Vasc Anesth. 2018 Feb;32(1):297-301. doi: 10.1053/j.jvca.2017.07.026.
Morris BN, Fernando RJ, Garner CR, Johnson SD, Gardner JC, Marchant BE, et al. A Randomized Comparison of Positional Stability: The EZ-Blocker Versus Left-Sided Double-Lumen Endobronchial Tubes in Adult Patients Undergoing Thoracic Surgery. J Cardiothorac Vasc Anesth. 2020 Nov 28:S1053-0770(20)31291-X. doi: 10.1053/j.jvca.2020.11.056.
Grocott HP, Darrow TR, Whiteheart DL, Glower DD, Smith MS. Lung isolation during port-access cardiac surgery: double-lumen endotracheal tube versus single-lumen endotracheal tube with a bronchial blocker. J Cardiothorac Vasc Anesth. 2003 Dec;17(6):725-7. doi: 10.1053/j.jvca.2003.09.012.
Obaidi RA, O'Hear KE, Kulkarni VN, Brodsky JB, Shrager JB. Failure to Isolate the Right Lung with an EZ-Blocker. A A Case Rep. 2014 Oct 15;3(8):110-1. doi: 10.1213/XAA.0000000000000056.
Yoo JY, Kim DH, Choi H, Kim K, Chae YJ, Park SY. Disconnection technique with a bronchial blocker for improving lung deflation: a comparison with a double-lumen tube and bronchial blocker without disconnection. J Cardiothorac Vasc Anesth. 2014 Aug;28(4):904-7. doi: 10.1053/j.jvca.2013.07.019.
Cheng Q, He Z, Xue P, Xu Q, Zhu M, Chen W, et al. The disconnection technique with the use of a bronchial blocker for improving nonventilated lung collapse in video-assisted thoracoscopic surgery. J Thorac Dis. 2020 Mar;12(3):876-882. doi: 10.21037/jtd.2019.12.75.
Knoll H, Ziegeler S, Schreiber JU, Buchinger H, Bialas P, Semyonov K, et al. Airway injuries after one-lung ventilation: a comparison between double-lumen tube and endobronchial blocker: a randomized, prospective, controlled trial. Anesthesiology. 2006 Sep;105(3):471-7. doi: 10.1097/00000542-200609000-00009.
Moritz A, Irouschek A, Birkholz T, Prottengeier J, Sirbu H, Schmidt J. The EZ-blocker for one-lung ventilation in patients undergoing thoracic surgery: clinical applications and experience in 100 cases in a routine clinical setting. J Cardiothorac Surg. 2018 Jun 25;13(1):77. doi: 10.1186/s13019-018-0767-9.
Mourisse J, Liesveld J, Verhagen A, van Rooij G, van der Heide S, Schuurbiers-Siebers O, et al. Efficiency, efficacy, and safety of EZ-blocker compared with left-sided double-lumen tube for one-lung ventilation. Anesthesiology. 2013 Mar;118(3):550-61. doi: 10.1097/ALN.0b013e3182834f2d.
Zhong T, Wang W, Chen J, Ran L, Story DA. Sore throat or hoarse voice with bronchial blockers or double-lumen tubes for lung isolation: a randomised, prospective trial. Anaesth Intensive Care. 2009 May;37(3):441-6.
How to Cite
Copyright (c) 2021 Onat Bermede
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.