Endobronchial blocker

This rarely seen item was used as a visual prop in Question 24.1 from the second paper of 2012. The candidates weren't expected to recognise it- the examiners were more interested in its uses, advantages and disadvantages.

Indications for the use of the endobronchial blocker rather than DLT:

Cannot use the dual lumen tube:

• nasal intubation
• small patient
• difficult intubation
• patient with a tracheostomy
• subglottic stenosis
• thick and excessive secretions

Advantages of the endobronchial blocker

• Can use the current normal ETT- no need to insert a DLT
• Safer than the DLT in patients with a traumatic airway injury
• Can provide selective lobar blockade of a specific lobe, rather than of the entire lung

• Technically, simpler than DLT insertion

Disadvantages of the endobronchial blocker

The college suggest the following:

• Do not allow suctioning of deflated lung due to small lumen
• Requires ETT >7.5mm diameter.
• Collapse of desired lung may be slow
• Easily dislodged
• Risk of perforation of bronchus or lung parenchyma
• Difficult to block R upper lobe bronchus due to variable take-off.

To this I would add:

• Surgery on a mainstem bronchus is impossible if the bronchus is blocked
• Bronchoscopy of the blocked lung is impossible