Successful One-Lung Ventilation with Fogarty Balloon for Thoracotomy Lobectomy in A 5-Year-Old Girl
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Introduction: Pediatric thoracic surgery, particularly lung resection, has special difficulties due to anatomical and physiological differences compared to adults. One-lung ventilation (OLV) is often necessary to optimize surgical exposure while minimizing lung injury. Traditional methods, like double-lumen endotracheal tubes, can be difficult to use in children due to their smaller airways and the risk of trauma. Thus, alternative approaches, such as bronchial blockers like Fogarty occlusion catheters, have gained prominence.
Objective: This case report aims to highlight the use of the Fogarty balloon in a pediatric patient undergoing lobectomy for organized pleural effusion linked to pneumonia.
Case Report: A 5-year-old girl with recurrent pneumonia presented with persistent cough, intermittent fever, and respiratory distress. Physical examination revealed decreased breath sounds and mild cyanosis. Imaging confirmed a large organized pleural effusion, suspected to be empyema. The surgical team chose a right thoracotomy lobectomy to remove the affected lung tissue. Preoperative consultations included pediatric surgery, anesthesiology, and respiratory therapy to ensure comprehensive care. A multi-modal pain management strategy, emphasizing regional anesthesia through epidural blocks, was implemented. For OLV, the anesthetic team selected a Fogarty balloon catheter to minimize airway trauma. After intubating with a single-lumen endotracheal tube, the balloon was inserted into the right main bronchus and inflated to occlude it, allowing ventilation of the left lung.
Discussion: The Fogarty balloon effectively provided lung isolation while preserving airway integrity, facilitating optimal surgical exposure and stable oxygenation. Continuous monitoring of oxygenation during OLV was crucial for patient safety.
Conclusion: The use of a Fogarty balloon for bronchial blockade and epidural anesthesia was successful in this pediatric lobectomy case. These techniques enhanced surgical safety, efficacy, and postoperative recovery, suggesting that there must be ongoing research to establish standardized protocols for pediatric thoracic procedures.
Yonezawa H, Kawanishi R, Sasaki H, Sogabe Y, Hirota K, Honda Y, et al. Insertion of a Fogarty catheter through a slip joint section for neonatal and infantile one-lung ventilation: a report of two cases. The Journal of Medical Investigation. 2021; 68(1.2): 209–12.
Kamra SK, Jaiswal AA, Garg AK, Mohanty MK. Rigid Bronchoscopic Placement of Fogarty Catheter as a Bronchial Blocker for One Lung Isolation and Ventilation in Infants and Children Undergoing Thoracic Surgery: A Single Institution Experience of 27 Cases. Indian Journal of Otolaryngology and Head & Neck Surgery. 2017; 69(2): 159–71.
Weiskopf RB, Campos JH. Current Techniques for Perioperative Lung Isolation in Adults. Anesthesiology. 2002; 97(5).
Kurniyanta P, Putra KAH, Senapathi TGA, Suryadi IA. Airway and Ventilatory Management in a Premature Neonate with Congenital Tracheoesophageal Fistula. Bali Journal of Anesthesiology. 2021; 5(2).
Kwon JY, Lee KH, Lee SE, Kim YH, Shin SH. A new formula for selecting the size of cuffed endotracheal tubes in pediatric patients. Bali Journal of Anesthesiology. 2023; 7(3).
Behera BK, Misra S, Mohanty MK, Tripathy BB. Use of Fogarty catheter as bronchial blocker for lung isolation in children undergoing thoracic surgery: A single centre experience of 15 cases. Ann Card Anaesth. 2022; 25(2).
Cano PA, Mora LC, Enríquez I, Reis MS, Martínez E, Barturen F. One-lung ventilation with a bronchial blocker in thoracic patients. BMC Anesthesiol. 2023; 23(1): 398.
Putu Fajar Narakusuma I, Kurniyanta P, Wangsa A. Laporan kasus teknik One Lung Ventilation (OLV) pada anak usia 4 tahun yang menjalani Video Assisted Thoracoscopy Surgery (VATS) bullectomy. Fakultas Kedokteran Universitas Udayana | Medicina. 2023; 54(1): 1–4.
Goetschi M, Kemper M, Kleine-Brueggeney M, Dave MH, Weiss M. Inflation volume-balloon diameter and inflation pressure-balloon diameter characteristics of commonly used bronchial blocker balloons for single-lung ventilation in children. Pediatric Anesthesia. 2021; 31(4): 474–81.
Durkin C, Romano K, Egan S, Lohser J. Hypoxemia During One-Lung Ventilation: Does It Really Matter? Curr Anesthesiol Rep. 2021; 11(4): 414–20.
Şentürk M, Slinger P, Cohen E. Intraoperative mechanical ventilation strategies for one-lung ventilation. Best Pract Res Clin Anaesthesiol. 2015; 29(3): 357–69.
Campos JH, Feider A. Hypoxia During One-Lung Ventilation-A Review and Update. J Cardiothorac Vasc Anesth. 2018; 32(5): 2330–8.
Templeton TW, Miller SA, Lee LK, Kheterpal S, Mathis MR, Goenaga-Díaz EJ, et al. Hypoxemia in Young Children Undergoing One-lung Ventilation: A Retrospective Cohort Study. Anesthesiology. 2021; 135(5).
Bernasconi Filippo, Piccioni Federico. One-lung Ventilation for Thoracic Surgery: Current Perspectives. Tumori Journal. 2017; 103(6): 495–503.
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