To the Editor:—
A Fogarty or Foley catheter has been used as a bronchial blocker when one-lung ventilation is necessary in children. 1–4The blocker catheter can be passed either through 1,2or alongside 3,4the endotracheal tube. In the former method, the catheter usually is inserted into an endotracheal tube through a right-angle connector with a self-sealing diaphragm or suction port. 1,2One major problem associated with this method is that the blocker may easily be dislodged when the connector is detached from the endotracheal tube (e.g. , to insert a suction catheter into the trachea) or when a fiberscope is inserted into or removed from the endotracheal tube alongside the catheter to confirm the blocker position. We report a simple method to minimize this problem.
A 1-month-old boy with congenital cystic adenomatoid malformation of the left lung was scheduled for left upper lobectomy. Chest radiography showed that the mediastinum was markedly shifted to the right. We planned to block the left bronchus after induction of anesthesia, but before injection of a muscle relaxant, to minimize further expansion of the left lung. In the operating room, anesthesia was induced by inhalation of an increasing concentration of sevoflurane in oxygen.
A small hole was made to the side of an endotracheal tube (3.5 mm ID) close to the tube connector. An 18-gauge needle was used to pierce the tube, and the needle was rotated to make a round hole. Resulting debris was removed. A 3-French Fogarty catheter, with its tip curved, was passed through the hole into the tube (fig. 1),
and integrity of the cuff of the catheter was confirmed. The combination was inserted into the trachea using a laryngoscope, and adequate ventilation was confirmed. A fiberoptic bronchoscope was inserted into the endotracheal tube (via a self-sealing connector), and the Fogarty catheter was advanced easily into the left bronchus during fiberoptic view. The fiberscope was removed, and a transparent drape was used to cover the endotracheal tube hole through which the Fogarty catheter entered. After adequate one-lung ventilation was confirmed, vecuronium was injected. Throughout the operation, which was performed without complication, the Fogarty catheter was not dislodged, and there was no gas leak around the tube hole.
Because the Fogarty catheter was inserted through a hole made to the side of the endotracheal tube (fig. 1), there was little risk of dislodgment of the Fogarty catheter during detachment or attachment of the right-angle connector or during insertion of the fiberscope into and its removal from the endotracheal tube. It was easy to affix the catheter to the endotracheal tube using adhesive tape. Although the manufacturer may not accept liability for a modified device, we believe that this method is clinically useful.
