Bronchial Blockers

Several days ago, I wrote a post on the use of double lumen tubes to achieve lung isolation. The other deice we occasionally use for lung surgeries is something called a bronchial blocker. With a normal endotracheal breathing tube in place, we can insert a long, thin, balloon tipped catheter down into one of the mainstem bronchi. If we inflate the balloon, that side will not be ventilated, allowing a surgeon to work. There are many different advantages and disadvantages to using a bronchial blocker over an endotracheal tube, and the thoracic anesthesia rotation is our primary time to learn and familiarize ourselves with these devices.

In the diagram shown above, an endotracheal tube with an inflated balloon is positioned above the carina or first branchpoint of the lungs. A flexible fiberoptic bronchoscope in solid black is introduced down to the tube to hine light down the right mainstem bronchus. The bronchial blocker also passes through the tube and is guided (either mechanically or by a lasso) down that right side. When the balloon is in the right place, the camera should see the images shown. It's pretty satisfying to look over the drapes into the surgical side and see the successful deflation of the operative lung.

Image is in the public domain, from openi.nlm.nih.gov.