Cadaveric evaluation of fluoroscopy‐assisted placement of one‐lung ventilation devices for video‐assisted thoracoscopic surgery in dogs

• Published in: Veterinary surgery 2020-06, Vol.49 (S1), p.O93-O101
• Main Authors: Mayhew, Philipp D., Chohan, Amandeep, Hardy, Brian T., Singh, Ameet, Case, J. Brad, Giuffrida, Michelle A., Culp, William T. N.
• Format: Article
• Language: English
• Subjects: Bronchoscopy; Cadavers; Devices; Dogs; Feasibility; Fluoroscopy; Lungs; Mechanical ventilation; Placement; Population studies; Surgery; Ventilation
• ISSN: 0161-3499; 1532-950X
• DOI: 10.1111/vsu.13331

Objective To evaluate the feasibility of fluoroscopy‐assisted placement of one‐lung ventilation (OLV) devices in dogs. Study design Experimental study. Sample population Canine cadavers (n = 8) weighing between 20.2 and 37.4 kg. Methods Thoracoscopic access with a two‐port approach was established to evaluate bilateral lung ventilation patterns. Advancement of a left‐sided Robertshaw double‐lumen endobronchial tube (DLT) and the EZ‐blocker (EZ) were evaluated under direct fluoroscopic guidance. Each dog also underwent bronchoscopy‐assisted placement of an Arndt endobronchial blocker (EBB). Time to initial placement, success of creating complete OLV (after initial placement attempt and after up to two repositionings), and ease of placement score were recorded. Device position was evaluated bronchoscopically after each fluoroscopy‐assisted placement attempt. Results Time to initial placement was significantly shorter for EZ than for DLT and EBB. The rate of successful placement after up to two repositioning attempts was 87.5%, 87.5%, and 100.0% on the right and 87.5%, 100.0%, 100.0% on the left for DLT, EZ, and EBB, respectively, and was not different between devices. Ease of placement scores were significantly higher for DLT compared with EZ and EBB on both the left and the right sides. Conclusion Fluoroscopy‐assisted placement of DLT and EZ appears feasible in canine cadavers. EZ‐blocker placement was efficient and technically easier than DLT, but positioning must be adapted for dogs. Bronchoscopy‐assisted placement of EBB remains highly successful. Clinical significance Fluoroscopy‐assisted placement of EZ and DLT is a useful alternative to bronchoscopy‐assisted placement of these OLV devices.