|
Previous article 
Next article |
|
|
ORIGINAL ARTICLE
Year : 2012 | Volume
: 6
| Issue : 3 | Page : 192-196
Anesthesia for thoracic surgery: A survey of middle eastern practice
Abdelazeem Eldawlatly1, Ahmed Turkistani1, Ben Shelley2, Mohamed El-Tahan3, Alistair Macfie4, John Kinsella2, Thoracic-anaesthesia Group Collaborators1
1 Department of Anesthesia, College of Medicine, King Saud University, Riyadh, Saudi Arabia
2 Academic Unit of Anaesthesia, Pain and Critical Care Medicine, University of Glasgow; Department of Anaesthesia, West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom
3 Department of Anesthesia, University of Dammam, Dammam, Saudi Arabia
4 Department of Anaesthesia, West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom
Correspondence Address:
Abdelazeem Eldawlatly
Department of Anesthesia, College of Medicine, King Saud University, Riyadh
Saudi Arabia
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/1658-354X.101196
| Date of Web Publication | 21-Sep-2012 |
|
|
Purpose: The main objective of this survey is to describe the current practice of thoracic anesthesia in the Middle Eastern (ME) region. Methods: A prospective online survey. An invitation to participate was e-mailed to all members of the ME thoracic-anaesthesia group. A total of 58 members participated in the survey from 19 institutions in the Middle East. Questions concerned ventilation strategies during one-lung ventilation (OLV), anesthesia regimen, mode of postoperative analgesia, use of lung isolation techniques, and use of i.v. fluids. Results: Volume-controlled ventilation was favored over pressure-controlled ventilation (62% vs 38% of respondents, P<0.05); 43% report the routine use of positive end-expiratory pressure. One hundred percent of respondents report using double-lumen tube (DLT) as a first choice airway to establish OLV. Nearly a third of respondents, 31.1%, report never using bronchial blocker (BB) in their thoracic anesthesia practice. Failure to pass a DLT and difficult airway are the most commonly cited indications for BB use. Regarding postoperative analgesia, the majority 61.8% favor thoracic epidural analgesia over other techniques (P<0.05). Conclusions: Our survey provides a contemporary snapshot of the ME thoracic anesthetic practice. Keywords: Middle east, survey, thoracic anesthesia
How to cite this article:
Eldawlatly A, Turkistani A, Shelley B, El-Tahan M, Macfie A, Kinsella J, Ta. Anesthesia for thoracic surgery: A survey of middle eastern practice. Saudi J Anaesth 2012;6:192-6 |
How to cite this URL:
Eldawlatly A, Turkistani A, Shelley B, El-Tahan M, Macfie A, Kinsella J, Ta. Anesthesia for thoracic surgery: A survey of middle eastern practice. Saudi J Anaesth [serial online] 2012 [cited 2022 Jun 27];6:192-6. Available from: https://www.saudija.org/text.asp?2012/6/3/192/101196 |
| Introduction | |  |
Thoracic anesthesia is a challenging subspecialty. In addition to the generic challenges of major surgery, the anesthetist is faced with the additional demands of establishing lung isolation. Hypoxemia associated with one-lung ventilation (OLV) has a reported incidence of 5-10%, while both the duration of OLV and high intraoperative ventilatory pressures are established risk factors for postoperative acute lung injury. [1],[2]
Consequently, ventilator strategies have been developed seeking to maintain oxygenation during OLV while ameliorating postoperative lung injury. Such strategies include the use of positive end-expiratory pressure (PEEP) to the ventilated lung or continuous positive airway pressure to the collapsed lung, selection of pressure-controlled over volume-controlled ventilation (VCV), reducing the fraction of inspired oxygen (FiO 2 ) and reducing tidal volume. The evidence base for such interventions is not conclusive with opinion and practice varying widely. [3],[4],[5],[6],[7] Choice of lung separation device is another important issue in anesthesia for general thoracic surgery. The commonest technique is the use of double-lumen endobronchial tube (DLT). Left-sided DLTs are widely used to achieve OLV in thoracic anesthesia, while the proximal take off of the right upper lobe bronchus makes positioning of a right-sided DLT more technically challenging. As a result, the use of right-sided DLT is the subject of some controversy; some have gone as far as to suggest that right-sided DLT should not be routinely used in thoracic anesthetic practice. [8],[9] OLV can also be achieved with the use of bronchial blockers (BB), a technique which has been described as having a role in patients with a difficult airway. [10],[11],[12]
Provision of analgesia for thoracotomy is a further challenge to the thoracic anesthetist. Thoracic epidural analgesia (TEA) has long been considered the gold standard technique for post-thoracotomy pain relief. Recent studies however have reported that paravertebral block (PVB) is effective as TEA in treating post-thoracotomy pain and may be associated with a reduction in postoperative complications. [13],[14],[15],[16] Shelley et al. recently conducted a survey of UK thoracic anesthesiologists exploring many of the above issues with interesting results. [17] We sought to carry out a similar survey among Middle Eastern (ME) thoracic anesthetists with the aim of describing the current practice of thoracic anesthesia in the region.
| Methods | | |
Permission was obtained from Shelley et al. to use their survey protocol via the commercially available "Survey Monkey" software (www.surveymonkey.com). [17] An electronic invitation message was sent to all 129 members of the ME thoracic anesthesia group (http://health.groups.yahoo.com/group/thoracic-anaesthesia/). The thoracic anesthesia group was founded in November 1999 with the aim of providing a forum for the exchange of ideas and experiences pertinent to the practice of thoracic anesthesia in the ME region. Participants were requested to complete questions in the context of their "current routine 'first choice' practice when anesthetizing for lobectomy/pneumonectomy with one-lung ventilation… in the absence of any contraindications or special (patient) considerations."
Questions concerned anesthetic technique, mode of ventilation during the period of OLV, regional analgesic technique (if any), adjunctive analgesia, perioperative fluid management, and choice of lung separation technique. Mann-Whitney test was used to compare continuous data and Chi Square test was used to compare categorical data. P<0.05 was considered statistically significant. Data analysis was carried out using SPSS software version 13.
| Results | | |
A total of 58 members of the thoracic anesthesia group participated in the survey from 19 institutions in the Middle East. This corresponds to a response rate of 45%.
Anesthetic technique
For 84% of respondents, sevoflurane was the inhalational anesthetic of choice during OLV (P<0.05 compared with other agents). Only 16.9% of the respondents used total intravenous anesthesia with propofol during OLV.
Method of one-lung ventilation
VCV was favored over pressure-controlled ventilation (PCV) mode (62 vs 37.9%), though this difference was not statistically significant (P=0.8). Fifty-two percent of respondents reported that they ventilate with a target tidal volume (Vt) of 4-6 ml/kg body weight. Fifty-three percent of respondents reported the adoption of permissive approach to hypercapnia during OLV vs 47.2% who do not (not significant). The distribution of FiO 2 chosen during the period of OLV (assuming hypoxia is not an issue) is bimodal. Fifty percent of the respondents report routinely ventilating with a FiO 2 of 1, while 19% favor an FiO 2 of between 0.4 and 0.5 [Figure 1]. Forty-three percent of respondents reported that they routinely use PEEP during OLV with the majority of those using 5 cmH 2 O PEEP. | Figure 1: The range of FIO2 routinely used by respondents during the period of one-lung ventilation
Click here to view |
Choice of lung separation technique
Forty-seven participants responded to the section on choice of lung separation technique. All reported that they use a DLT as first choice technique to establish OLV for open thoracotomy for lung resection. Fifty-four percent of respondents favor using left-sided DLTs for all pathologies. The most commonly cited indication for right-sided DLT use is for lesions of the left proximal main-stem bronchus [Table 1] and [Table 2].
Nearly a third of respondents, 31%, report never using BB in their thoracic anesthetic practice. Of the 69% of respondents reporting use of BB, these are principally utilized in case of failure to pass a DLT and in patients with a difficult airway [Table 3].
Postoperative analgesia
TEA is favored by the majority of respondents [Table 4]. Fifty-eight percent of respondents report that they establish the epidural block before induction of general anesthesia. Bupivacaine was reported as the drug of choice for TEA in the majority of cases (89.7%), most commonly with fentanyl as an additive (96.2%). Only 9.1% reported the use of PVB as the preferred analgesic modality. | Table 4: First choice regional analgesic technique for open thoracotomy and lung resection
Click here to view |
Perioperative fluid management
Regarding intraoperative fluid management, 23% report using normal saline while 56% report using Lactated Ringer solution (the remainder reported using other types of fluids). Forty percent answered that they are using the fluids according to ml/kg body weight formula where 60% report liberal intraoperative fluid replacement. Assuming blood loss is not exceptional, the majority of respondents, 61%, report giving 1-2 l of fluids intraoperatively. However, 29% report giving 0.5-1 l of fluids intraoperatively. Seven and 2% of the respondents report giving 2-3 and >3 l of fluids intraoperatively, respectively.
| Discussion | | |
Our results in this survey differ in many aspects from the survey conducted by Shelley et al. from United Kingdom (UK). [17] In our survey, most of the respondents were in favor of VCV in contradiction to the UK survey where the majority prefers using PCV mode during OLV. In both surveys, most of the participants were in favor of using PEEP during OLV. Definitive studies on the most effective ventilatory mode during OLV remain elusive. In a study comparing VCV vs PCV modes during OLV, Tugrul et al. demonstrated that PCV was associated with a statistically significant decrease in airway pressures and an improvement in oxygenation. [18] Though others have failed to demonstrate a similar improvement in oxygenation indices, the findings in terms of reduced airway pressure are consistent. [19],[20] In light of concerns about acute lung injury, this alone has been sufficient for some to conclude that PCV is the preferred mode of ventilation during OLV. [21] Respondents from the ME also tended to favor administering a higher FiO 2 during the period of OLV compared to UK respondents. This practice has recently been called into question in light of concerns over the potentially harmful effects of hyperoxia. [22]
Regarding the use of lung isolation techniques to achieve OLV, the majority of respondents to both surveys (ME and UK) favor the use of DLT. Left main bronchus lesions and left pneumonectomy were the most frequently cited indications for right-sided DLT in both surveys. In both surveys, most of the respondents reported rarely using BB to achieve OLV, though the majority will use them in cases of difficult airway. The use of BB for airway control and difficult airway management in thoracic anesthesia has recently been recommended by a panel of international experts. [23],[24] None of the surveys was designed to explore what types of BB are in clinical use. TEA was the method of choice for perioperative pain relief in both surveys. Most of the respondents to the ME survey reported establishing and confirming the onset of epidural blockade prior to induction of anesthesia compared to few respondents to the UK survey. PVB is the second method of choice for post-thoracotomy pain relief in both surveys. There is growing evidence that PVB is a safe alternative to TEA for post-thoracotomy pain after lung resection. [25] Our results demonstrate the variety of thoracic anesthesia practices throughout the ME region. Although there was general agreement between the respondents to both surveys regarding the use of DLTs and BBs, there was clear differences in opinion between the two regions on other issues. The main differences appear to be in the conduct of OLV. We suggest that the differences in the practice of thoracic anesthesia between the two regions reflect a more "traditional" approach to thoracic anesthesia in the ME. This may reflect the absence of a subspecialty society, limited access to subspecialty continuing professional development, and limited training opportunities in the ME region. In contrast, the UK has a very active association of cardiothoracic anesthetists hosting biannual subspecialty educational meetings (www.acta.org.uk); in addition, fellowships/training programs for cardiothoracic anesthetic trainees are commonplace.
In conclusion, we have attempted to provide a broad overview of the current practice of thoracic anesthesia in the ME region. We believe significant inroads are being made by the ME thoracic anesthesia group, both in terms of education and training, but suggest more could be done to ensure that thoracic anesthesia practice in the ME remains up-to-date and develops in parallel with western contemporaries.
| Acknowledgment | | |
The author would like to thank all members the thoracic anesthesia group for their participation in this survey.
Thoracic-anaesthesia group collaborators
- Members who mentioned their names and their institutes names: Mohamed Delvi, Waseem Hajjar, Sami Al-Nassar, Jumana Baaj, Badiah Abdulghani (College of Medicine, King Saud University, Riyadh, KSA), Abdulhadi Alsaflan (University of Dammam, KSA), Mussarat Afzal (King Fahad specialist Hospital, Dammam, KSA), Nasser Alkemyani (Sultan Qaboos University Hospital, Oman), Mohamed Abdulatif, Fawzia Aboelfetouh, Ezz El-Din Fikri Ismail, Mohamed Osman, Hisham Hosny (College of Medicine, Cairo University, Egypt), Khaled Abdullah (College of Medicine, Ain Shams University, Egypt), Mutlaq Althubaiti (Riyadh Military Hospital, KSA), Saad Al-Shamma (Al-yarmook Teaching Hospital, Baghdad-Iraq), Mohamed Moniem (Sharjah University Hospital, Sharjah, United Arab Emirates).
- Members who mentioned only their institutes names: King Fahad Hospital (Almadinah Almunawarah, KSA), King Abdullah Medical City (Makah, KSA), Jordan University Hospital (Jordan), Kuwait University Hospital (Kuwait), International Medical Centre (Egypt), King Faisal Specialists Hospital (Riyadh, KSA), Suez Canal University Hospital (Ismailia, Egypt), Dr. Soliman Fakeeh Hospital (Jeddah, KSA), National guard Hospital (Riyadh, KSA), Arab Contractor Medical Centre (Cairo, Egypt).
| References | | |
| 1. | Karazai W, Schwarzkopf K. Hypoxemia during one-lung ventilation. Anesthesiology 2009;110:1402-1. 
|
| 2. | Licker M, de Perrot M, Spiliopoulos A, Robert J, Diaper J, Chevalley C, et al. Risk factors for acute lung injury after thoracic surgery for lung cancer. Anesth Analg 2003;97:1558-65.
[PUBMED] |
| 3. | Ng A, Swanevelder J. Hypoxemia associated with one-lung anaesthesia: New discoveries in ventilation and perfusion. Br J Anaesth 2011;106:761-3.
[PUBMED] |
| 4. | Michelet P, Roch A, Brousse D, D'Journo XB, Bregeon F, Lambert D, et al. Effects of PEEP on oxygenation and respiratory mechanics during one-lung ventilation. Br J Anaesth 2005;95:267-73.
[PUBMED] |
| 5. | El-Tahan MR, El Ghoneimy YF, Regal MA, El Emam H. Comparative study of the non-dependent continuous positive pressure ventilation and high-frequency positive-pressure ventilation during one-lung ventilation for video-assisted thoracoscopic surgery. Interact Cardiovasc Thorac Surg 2011;12:899-902.
[PUBMED] |
| 6. | Della Rocca G, Coccia C. Ventilatory management of one-lung ventilation. Minerva Anestesiol 2011;77:534-6.
[PUBMED] |
| 7. | Montes FR, Pardo DF, Charrís H, Tellez LJ, Garzón JC, Osorio C. Comparison of two protective lung ventilatory regimes on oxygenation during one-lung ventilation: A randomized controlled trial. J Cardiothorac Surg 2010;5:99-103.
|
| 8. | Ehrenfeld JM, Walsh JL, Sandberg WS. Right- and left-sided Mallinckrodt double-lumen tubes have identical clinical performance. Anesth Analg 2008;106:1847-52.
[PUBMED] |
| 9. | Cohen E. Con: Right-sided double-lumen endotracheal tubes should not be routinely used in thoracic surgery. J Cardiothorac Vasc Anesth 2002;16:249-52.
[PUBMED] |
| 10. | Campos JH. Lung isolation techniques for patients with difficult airway. Curr Opin Anaesthesiol 2010;23:12-7.
[PUBMED] |
| 11. | Narayanaswamy M, McRae K, Slinger P, Dugas G, Kanellakos GW, Roscoe A, et al. Choosing a lung isolation device for thoracic surgery: A randomized trial of three bronchial blockers versus double-lumen tubes. Anesth Analg 2009;108:1097-101.
[PUBMED] |
| 12. | Ruetzler K, Grubhofer G, Schmid W, Papp D, Nabecker S, Hutschala D, et al. Randomized clinical trial comparing double-lumen tube and EZ-blocker for single-lung ventilation. Br J Anaesth 2011;106:896-902.
[PUBMED] |
| 13. | Elsayed H, McKevith J, McShane J, Scawn N. Thoracic epidural or paravertebral catheter for analgesia after lung resection: Is the outcome different? J Cardiothorac Vasc Anesth 2012;26:78-82.
[PUBMED] |
| 14. | Davies R, Myles P, Graham J. A comparison of the analgesic efficacy and side effects of paravertebral vs epidural blockade for thoracotomy: A systematic review and meta-analysis of randomization trials. Br J Anaesth 2006;96:418-26.
|
| 15. | Powell ES, Pearce AC, Cook D, Davies P, Bishay E, Bowler GM, et al. UKPOS co-ordinators. UK pneumonectomy outcome study (UKPOS): A prospective observational study of pneumonectomy outcome. J Cardiothorac Surg 2009;4:41.
[PUBMED] |
| 16. | Grider JS, Mullet TW, Saha SP, Harned ME, Sloan PA. A randomized, double-blind trial comparing continuous thoracic epidural bupivacaine with and without opioid in contrast to a continuous paravertebral infusion of bupivacaine for post-thoracotomy pain. J Cardiothorac Vasc Anesth 2012;26:83-9.
[PUBMED] |
| 17. | Shelley B, Macfie A, Kinsella J. Anesthesia for thoracic surgery: A survey of UK practice. J Cardiothorac Vasc Anesth 2011;25:1014-7.
[PUBMED] |
| 18. | Tugrul M, Camci E, Karadeniz H, Sentürk M, Pembeci K, Akpir K. Comparison of volume-controlled with pressure-controlled ventilation during one-lung anaesthesia. Br J Anaesth 1997;79:306-10.
|
| 19. | Unzueta MC, Casas JI, Moral MV. Pressure-controlled versus volume-controlled ventilation during one-lung ventilation for thoracic surgery. Anesth Analg 2007;104:1029-33.
[PUBMED] |
| 20. | Pardos PC, Garutti I, Pineiro P, Olmedilla L, de la Gala F. Effects of ventilatory mode during one-lung ventilation on intraoperative and postoperative oxygenation in thoracic surgery. J Cardiothorac Vasc Anesth 2009;23:770-4.
|
| 21. | Lohser J. Evidence-based management of one-lung ventilation. Anesthesiol Clin 2008;26:241-72.
[PUBMED] |
| 22. | Grocott H. Oxygen toxicity during one-lung ventilation: Is it time to re-evaluate our practice? Anesthesiol Clin 2008;26:273-80.
|
| 23. | Merli G, Guarino A, Della Rocca G, Frova G, Petrini F, Sorbello M, et al. Recommendations for airway control and difficult airway management in thoracic anesthesia and lung separation procedures. Minerva Anestesiol 2009;75:59-96.
[PUBMED] |
| 24. | Cohen E. Recommendations for airway control and difficult airway management in thoracic anesthesia and lung separation procedures. Are we ready for the challenge? Minerva Anestesiol 2009;75:3-5.
[PUBMED] |
| 25. | Kaya FN, Turker G, Mogol EB, Bayrakter S. Thoracic paravertebral block for video-assisted thoracoscopic surgery: Single injection versus multiple injections. J Cardiothorac Vasc Anesth 2012;26:90-4.
|
[Figure 1]
[Table 1], [Table 2], [Table 3], [Table 4]
| This article has been cited by | | 1 |
Anästhesiologisches Management bei operativen Eingriffen am Thorax – eine Auswertung aus dem Deutschen Thoraxregister |
|
| H. Niedmers, J. M. Defosse, F. Wappler, A. Lopez, M. Schieren | | Der Anaesthesist. 2022; | | [Pubmed] | [DOI] | | | 2 |
Variation in postoperative pain management after lung surgery in the Netherlands: a survey of Dutch thoracic surgeons |
|
| Louisa N. Spaans, Jelle E. Bousema, Frank J.C. van den Broek | | British Journal of Anaesthesia. 2022; | | [Pubmed] | [DOI] | | | 3 |
Clinical guide to perioperative management for videothoracoscopy lung resection (Section of Cardiac, Vascular and Thoracic Anesthesia, SEDAR; Spanish Society of Thoracic Surgery, SECT; Spanish Society of Physiotherapy) |
|
| M. Granell-Gil, M. Murcia-Anaya, S. Sevilla, R. Martínez-Plumed, E. Biosca-Pérez, F. Cózar-Bernal, I. Garutti, L. Gallart, B. Ubierna-Ferreras, I. Sukia-Zilbeti, C. Gálvez-Muñoz, M. Delgado-Roel, L. Mínguez, S. Bermejo, O. Valencia, M. Real, C. Unzueta, C. Ferrando, F. Sánchez, S. González, C. Ruiz-Villén, A. Lluch, A. Hernández, J. Hernández-Beslmeisl, M. Vives, R. Vicente | | Revista Española de Anestesiología y Reanimación (English Edition). 2022; | | [Pubmed] | [DOI] | | | 4 |
Pain Management Strategies for Minimally Invasive Cardiothoracic Surgery |
|
| Elan A. Sherazee, Sarah A. Chen, David Li, David Li, Paul Frank, Bob Kiaii | | Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery. 2022; : 1556984522 | | [Pubmed] | [DOI] | | | 5 |
Current practice of thoracic anaesthesia in Europe – a survey by the European Society of Anaesthesiology Part I – airway management and regional anaesthesia techniques |
|
| Jerome Defosse, Mark Schieren, Torsten Loop, Vera von Dossow, Frank Wappler, Marcelo Gama de Abreu, Mark Ulrich Gerbershagen | | BMC Anesthesiology. 2021; 21(1) | | [Pubmed] | [DOI] | | | 6 |
Difficult lung separation. An insight into the challenges faced during COVID-19 pandemic |
|
| AlaaM Khidr, MohamedR El Tahan | | Saudi Journal of Anaesthesia. 2021; 15(3): 300 | | [Pubmed] | [DOI] | | | 7 |
Lung separation in adult thoracic anesthesia |
|
| Isabelle Huybrechts, Turgay Tuna, LaszloL Szegedi | | Saudi Journal of Anaesthesia. 2021; 15(3): 272 | | [Pubmed] | [DOI] | | | 8 |
A Survey of the Practice of Thoracic Anesthesia in India |
|
| Swapnil Y. Parab, Abinash Patro, Priya Ranganathan, Madhavi Shetmahajan | | Journal of Cardiothoracic and Vascular Anesthesia. 2021; 35(5): 1416 | | [Pubmed] | [DOI] | | | 9 |
Guía clínica en el manejo perioperatorio para la cirugía de resección pulmonar por videotoracoscopia (Sección de Anestesia Cardiaca, Vascular y Torácica, SEDAR; Sociedad Española de Cirugía Torácica, SECT; Asociación Española de Fisioterapia, AEF) |
|
| M. Granell-Gil, M. Murcia-Anaya, S. Sevilla, R. Martínez-Plumed, E. Biosca-Pérez, F. Cózar-Bernal, I. Garutti, L. Gallart, B. Ubierna-Ferreras, I. Sukia-Zilbeti, C. Gálvez-Muñoz, M. Delgado-Roel, L. Mínguez, S. Bermejo, O. Valencia, M. Real, C. Unzueta, C. Ferrando, F. Sánchez, S. González, C. Ruiz-Villén, A. Lluch, A. Hernández, J. Hernández-Beslmeisl, M. Vives, R. Vicente | | Revista Española de Anestesiología y Reanimación. 2021; | | [Pubmed] | [DOI] | | | 10 |
Deutschlandweite Umfrage zur Thoraxanästhesie |
|
| J. Defosse,M. Schieren,A. Böhmer,V. von Dossow,T. Loop,F. Wappler,M. U. Gerbershagen | | Der Anaesthesist. 2016; 65(6): 449 | | [Pubmed] | [DOI] | | | 11 |
Choice of Fluid Therapy and Bleeding Risk After Cardiac Surgery |
|
| Sumeet Reddy,Shay McGuinness,Rachael Parke,Paul Young | | Journal of Cardiothoracic and Vascular Anesthesia. 2015; | | [Pubmed] | [DOI] | | | 12 |
Anästhesie in der Thoraxchirurgie |
|
| Matthias Neuner,Thomas Edrich,Peter Gerner | | Wiener klinisches Magazin. 2015; 18(4): 104 | | [Pubmed] | [DOI] | | | 13 |
A comparison of the disconnection technique with continuous bronchial suction for lung deflation when using the Arndt endobronchial blocker during video-assisted thoracoscopy |
|
| Mohamed R. El-Tahan | | European Journal of Anaesthesiology. 2015; 32(6): 411 | | [Pubmed] | [DOI] | | | 14 |
Effect of tidal volume on extravascular lung water content during one-lung ventilation for video-assisted thoracoscopic surgery |
|
| Hatem Qutub,Mohamed R. El-Tahan,Hany A. Mowafi,Yasser F. El Ghoneimy,Mohamed A. Regal,AbdulHadi A. Al Saflan | | European Journal of Anaesthesiology. 2014; 31(9): 466 | | [Pubmed] | [DOI] | | | 15 |
Isolation of the lung: Double-lumen tubes and endobronchial blockers |
|
| Marc Licker,Morgan Le Guen,John Diaper,Frédéric Triponez,Wolfram Karenovics | | Trends in Anaesthesia and Critical Care. 2014; | | [Pubmed] | [DOI] | |
|
|
|
| |
|
Search Pubmed for