Foley Catheter Used as Bronchial Blocker for One Lung Ventilation in a Patient with Tracheostomy - A Case Report

氣切病患行單肺麻醉時利用導尿管作支氣管阻塞器之病例報告

陳坤堡(Kuen-Pao Chen) ； 陳克章(Hut-Cheung Chan) ； 黃信哲(Shin-Jer Huang)

《Acta Anaesthesiologica Sinica》 33卷1期 (1995/03) Pp. 41-44

摘要

Anesthesia with one-lung ventilation is a good anesthetic technique for patients receiving thoracotomy in various underlying diseases. One lung ventilation can be achieved successfully by the application of a double-lumen endotracheal tube through the oral route. However, there are several situations such as low body weight, young age, difficult intubation, anatomic anomaly, and tamponading endobronchial bleeding in some adult patients, etc., in which lung separation by a double-lumen endotracheal tube may be relatively contraindicated because insertion is either difficult or dangerous. Bronchial blocker with a Fogarty embolectomy catheter has been used successfully for such situations. Here, we reported the clinical experience in using the Foley catheter as the bronchial blocker in a patient with tracheostomy.

關鍵字

Anesthetic Techniques: one-lung anesthesia ； Bronchial blocker, Foley catheter, tracheostomy ； Surgery: VATS (video assisted thoracoscopic surgery), thoracotomy

並列摘要

胸腔手術時，一般而言，麻醉醫師都會經由患者之口腔放置雙內腔氣管內管，以行單肺換氣之全身麻醉；然而，有一些情形可能無法順利放置此雙內腔之氣管內管，例如：病人體重過輕、年齡太小、困難插管、或解剖學上之變異等等；因此，有些麻醉醫師便使用一種支氣管阻塞器，以行單肺換氣。除了特别設計之支氣管阻塞器外，心臟血管外科用來清除血管內血栓或栓塞之導管（Fogarty embolectomy tube），亦可作為支氣管阻塞器。在此我們報告一個病例是，接受氣管切開術後仍有氣切氣管內管留置之病患，因胸部疾患須接受開胸手術，為使手術順利進行，行單肺換氣之全身麻醉是必須的；由於氣管切開傷口之癒合並不十分理想，為避免經口腔放置雙內腔氣管內管造成氣切傷口的損傷流血，經過與外科醫師討論後，認為使用支氣管阻塞器為可行之取代方法，但因本院缺乏支氣管阻塞器與上述之Fogarty embolectomy tube，故使用小兒留置導尿管經氣切氣管內管作為支氣管阻塞器。謹報告此一成功之臨床經驗。