Year : 2009 | Volume
: 12 | Issue : 1 | Page : 83--84
Selective lung separation with Fogarty catheter guided by an adult fiberoptic bronchoscope in a paediatric patient with situs inversus
Mahesh Kodivalasa, Gopinath Ramachandran
Department of Anaesthesiology and Critical Care, Nizams Institute of Medical Sciences, Hyderabad, India
Department of Anaesthesiology and Critical Care, Nizams Institute of Medical Sciences, Hyderabad 500 082, Andhra Pradesh
|How to cite this article:|
Kodivalasa M, Ramachandran G. Selective lung separation with Fogarty catheter guided by an adult fiberoptic bronchoscope in a paediatric patient with situs inversus.Ann Card Anaesth 2009;12:83-84
|How to cite this URL:|
Kodivalasa M, Ramachandran G. Selective lung separation with Fogarty catheter guided by an adult fiberoptic bronchoscope in a paediatric patient with situs inversus. Ann Card Anaesth [serial online] 2009 [cited 2020 Feb 28 ];12:83-84
Available from: http://www.annals.in/text.asp?2009/12/1/83/45021
Providing peri-operative care to infants and children undergoing thoracic surgery presents many challenges to paediatric surgeons and anaesthesiologists.  Innovative techniques are often required for lung separation in paediatric patients. We describe a lung separation technique which we have used in an 8-year-old female patient (height: 120 cm; weight: 21 kg) with situs inversus [Figure 1].
The patient was diagnosed to have left lung upper lobe bronchiectasis and was scheduled for left lung upper lobectomy. General anaethesia was induced with fentanyl, midazolam, thiopentone and rocuronium. A 5F Fogarty catheter  and an adult fiberoptic bronchoscope were then passed through a mouth gag. Fogarty catheter was passed into the left main bronchus under bronchoscopic guidance, and its cuff was placed proximal to the origin of the bronchus of the left upper lobe. Before the removal of the fiberoptic scope, the Fogarty catheter's cuff was inflated once with 2 cc of air to check the adequacy of bronchial seal. After the removal of the fiberoptic bronchoscope and the mouth gag, the Fogarty catheter was fixed at the angle of the mouth. The patient was then intubated with a 6.0-mm cuffed oral tracheal tube coaxial to the Fogarty catheter with the aid of a laryngoscope. After thoracotomy, in order to initiate lung separation, the breathing circuit was disconnected from the endotracheal tube (in order to achieve adequate deflation of the lung to be operated on); the Fogarty catheter cuff was inflated and ventilation resumed.
The airway anatomy in patients with situs inversus demands an innovative and meticulous plan for the placement of lung separation devices,  which often needs the aid of a paediatric fiberoptic bronchoscope. In those centres where only an adult fiberoptic bronchoscope is available, the modified technique that includes the placement of bronchial blocker first and intubation of the trachea later in the usual manner might be useful for lung separation.
The limited literature available on the appropriate lung separation technique in paediatric patients with situs inversus necessitates a careful and innovative plan for lung isolation with available resources.
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