To the Editor:—

One-lung ventilation is used commonly to facilitate intrathoracic surgery. Routinely used techniques include double-lumen endotracheal tubes and Univent tubes (Fuji System Corporation, Tokyo, Japan). 1,2However, in critically ill and trauma patients who have already undergone intubation with a standard cuffed endotracheal tube, switching the endotracheal tube may not be wise. Although it is easier to place the bronchial blocker coaxially through an endotracheal tube, one of the major drawbacks of this technique is the air leak from the circuit. 3Solutions suggested include use of bone wax and application of waterproof tape. However, if the blocker must be repositioned, all this needs to be undone. In addition, persistent air leak makes application of continuous positive end-expiratory pressure to the dependent lung impossible. Herein, we describe a simple technique for achieving an airtight seal while instituting one-lung ventilation with a coaxially placed bronchial blocker, a Fogarty occlusion catheter (model 62080814F; Baxter, Irvine, CA), 8/14-French, with a 10-ml balloon.

The Fogarty occlusion catheter is available in various sizes; the most commonly used model for adult patients is an 8/14-French catheter with a 10-ml balloon. The technique used is shown in figures 1 and 2.

Assembling the various parts in the depicted fashion allows simultaneous use of the fiberoptic bronchoscope for positioning and repositioning of the blocker during the entire procedure. In figure 1, the Fogarty catheter is shown passing through the distal TwistLock assemblies taken out of the Cath-Gard catheter contamination shield (Arrow International Inc., Reading, PA). The proximal TwistLock assemblies can be used also. In figure 2, a9-French Arrow-Flex sheath (Arrow International Inc., Reading, PA) with an integral hemostasis valve and side port, with the introducer sheath shortened and the side port clamped, is shown accepting the Fogarty catheter. Each Portex swivel adapter (SIMS Portex Inc., Keene, NH) is supplied with two self-sealing diaphragms for use with pediatric and adult bronchoscopes. Both devices make a perfect airtight fit with the pediatric self-sealing diaphragm of the Portex fiberoptic bronchoscope swivel adapter. After thoroughly lubricating the tip of the Fogarty catheter, the catheter is gently advanced through the previously mentioned devices in a rotating motion to prevent damage to the balloon. Use of two swivel adapters makes simultaneous bronchoscopy and continued uninterrupted ventilation possible. In the case of the TwistLock device, the advantage of the TwistLock mechanism keeps the bronchial blocker securely in position. All the described parts are readily available. In my experience, both the devices are equally efficient. However, it is preferable from the cost-effective standpoint to use the Cath-Gard contamination shield because spares are easy to find, and each shield has two TwistLock devices (proximal and distal); therefore, it is good

for two patients. While using the hemostasis valve, care should be taken to clamp the side port and cut off the tubing distal to the clamp to prevent inadvertent administration of drugs or intravenous fluids.

Slinger P: Con: The Univent tube is not the best method of providing one-lung ventilation. J Cardiothorac Vasc Anesth 1993; 7: 108–12
Gayes JM: Pro: One-lung ventilation is best accomplished with the Univent endotracheal tube. J Cardiothorac Vasc Anesth 1993; 7: 103–7
Larson CE TA Gasior: A device for endobronchial blocker placement during one-lung anesthesia (letter). Anesth Analg 1990; 71: 311–2