使用Wire-guided Endobronchial Blocker於氣管造口術病人，進行單肺換氣呼吸麻醉－－病例報告

Application of Wire-guided Endobronchial Blocker for One-lung Ventilation in Patient with Tracheostomy-- A Case Report

單肺換氣呼吸，通常使用double-lumen endobronchial tube or Univent tube完成。但某些呼吸道有問題或病情危急病人則不易使用。支氣管阻斷器觀念則被適度使用於此類病人。在此我們使用新型支氣管阻斷器於一有氣管造口之病人，利用reinforced tracheal tube及新型Arndt endobronchial blocker set，在小孩式光纖鏡導引下，完成單肺換氣呼吸。我們並且分析各種單肺呼吸管於此類病人的適用性，以供大家參考。

One-lung ventilation (OLV) with a double-lumen endotracheal tube or Univent may be achieved difficultly in morbidly obese, mouth opening-limited or critically ill patients. Now, a new fiberoptically directed wire-guided endobronchial blocker (WEB) can be applied for these conditions. We report the use of a new endobronchial blocker in a pharyngeal cancer patient after pharyngectomy. The original 10# Shiley endotracheal tube was exchanged with reinforced cuffed tracheal tube. Then we use the WEB to achieve OLV. The WEB was guided by a loop, and through the appropriate position of left main bronchus by pediatric fiberoptic bronchoscope. Finally, OLV was accomplished smoothly with combination of a non-kinking endotracheal tube and a WEB.