Update on selective lobar blockade during pulmonary resections

Abstract

Purpose of review: This review is an update on the advantages that selective lobar blockade provides in thoracic surgical patients who had previous contralateral lobectomy or pneumonectomy.

Recent findings: Selective lobar blockade while allowing surgical exposure also improves oxygenation in patients who cannot tolerate complete lung collapse due to limited reserve or previous lung surgery.

Summary: Selective lobar blockade is an alternative technique to achieve lobar collapse in patients who have had a previous lobectomy or pneumonectomy and require thoracic surgery. This selective blockade can be accomplished by using a bronchial blocker or a double-lumen endotracheal tube. In patients with previous bronchial resection, recognition of tracheobronchial anatomy with the fiberoptic bronchoscope is mandatory to increase the successful placement and function of lung isolation devices. The advantages of a selective blockade are to avoid total lung collapse and only block the lobe(s) in which surgery takes place and to improve intraoperative oxygenation.