Continuous positive airway pressure for treating hypoxemia due to pulmonary vein injury:A case report

BACKGROUND Vascular injury during thoracoscopic surgery for esophageal cancer is a rare but life-threatening complication that can lead to severe hypotension and hypoxemia.Anesthesiologists need to provide rapid and effective treatment to save patients'lives.CASE SUMMARY A 54-year-old male patient was scheduled to undergo a thoracoscopic-assisted radical resection of esophageal cancer through the upper abdomen and right chest.While dissociating the esophagus from the carina through the right chest,unexpected profuse bleeding occurred from a suspected pulmonary vascular hemorrhage.While the surgeon attempted to achieve hemostasis,the patient developed severe hypoxemia.The anesthesiologist implemented continuous positive airway pressure(CPAP)using a bronchial blocker(BB),which effectively improved the patient’s oxygenation and the operation was completed success-fully.CONCLUSION CPAP using a BB can resolve severe hypoxemia caused by accidental injury of the left inferior pulmonary vein during surgery.

持续气道正压通气治疗重症阻塞性睡眠呼吸暂停低通气综合征伴黏多糖病患儿1例

1临床资料患儿,男,6岁,因“睡眠打鼾2年余,加重伴憋气2 d”于2022-09-09就诊于甘肃省人民医院。患儿自幼体格生长和智力发育较同龄儿落后,面容特殊;入院前2年无明显诱因出现鼻塞、睡眠时张口呼吸,打鼾憋气,感冒时鼻塞、打鼾症状尤为明显,有时伴有耳痛。入院前1周患儿感冒后鼻塞加重,近两日夜间睡眠打鼾加重,伴明显憋气,夜间口唇青紫。患儿父母非近亲婚配,其家族中未发现类似情况。查体:身高63 cm,体重22 kg,特殊面容.

Creation method for bi-level positive airway pressure based on pressure and flow feedback

An airway pressure and flow data acquisition system is developed to investigate the approach to building the bi-level positive airway pressure BiPAP in a ventilator.A number of experiments under different breathing situations and states are conducted and the experimental data are recorded.According to the data from these experiments the variation characteristics of the pressure and flow are analyzed using Matlab. The data analysis results show that the pressure increases while the flow decreases in the expiratory phase contrarily the pressure decreases while the flow increases in the inspiratory phase during the apnea state both the pressure and the flow remain unchanged. According to the above variation characteristics of breath a feedback-based method for creating bi-level positive airway pressure is proposed. Experiments are implemented to verify the BiPAP model. Results demonstrate that the proposed method works effectively in following respiration and caters well to most polypnea and apnea events.

Large isolated fibrous tumors in the upper esophagus: A case report

BACKGROUND Solitary fibrous tumors(SFT)are rare spindle cell tumors that are usually benign.A total of 10 cases of SFTs in the upper esophagus have ever been reported.Here,we report the anesthetic management of a patient with a large isolated fibrous tumor of the upper esophagus compressing the tracheal membrane.We also provide a literature review of the current research.CASE SUMMARY We report the case of a 49 year old male with“cough aggravation and wheezing after exercise”,who underwent esophagectomy for a large isolated fibrous tumor compressing the tracheal membrane in the upper esophagus.We advise the use of a single-lumen tube with a blocker in patients with difficult airways to reduce the incidence of airway injury and fibrinoscopy at all stages of the perioperative period to guide airway management.This case study is the first report of the anesthetic management of a large,isolated fibrous tumor compressing the tracheal membrane in the upper esophagus.CONCLUSION This rare case emphasizes the importance of perioperative management of anesthesia in patients with large isolated fibrous tumors of the upper esophagus that compress the tracheal membrane.The use of blocker reduce the incidence of airway injury and fibrinoscopy at the perioperative period to guide airway mana-gement.

Obstructive sleep apnea:Overlooked comorbidity in patients with diabetes

In this review article,we explore the interplay between obstructive sleep apnea(OSA)and type 2 diabetes mellitus(T2DM),highlighting a significant yet often overlooked comorbidity.We delve into the pathophysiological links between OSA and diabetes,specifically how OSA exacerbates insulin resistance and disrupts glucose metabolism.The research examines the prevalence of OSA in diabetic patients and its role in worsening diabetes-related complications.Emphasizing the importance of comprehensive management,including weight control and positive airway pressure therapy,the study advocates integrated approaches to improve outcomes for patients with T2DM and OSA.This review underscores the necessity of recognizing and addressing OSA in diabetes care to ensure more effective treatment and better patient outcomes.

Recent advances in managing obstructive sleep apnea

Obstructive sleep apnea(OSA)is a rapidly increasing global concern.If it remains untreated,it can lead to cardiovascular,metabolic,and psychiatric complications and may result in premature death.The efficient and effective management of OSA can have a beneficial effect and help reduce the financial burden on the health sector.There has been constant development in OSA management,and numerous options are available.The mainstay of therapy is still the conventional measures and behavioral modifications.However,in cases of failure of these modalities,surgical therapy is the only option.Numerous studies have shown that proper management of OSA has beneficial effects with good long-term outcomes.

Noninvasive Ventilation Interfaces in the Treatment of Acute Respiratory Insufficiency: A Critical Review

Background: Noninvasive ventilation (NIV) is an important therapeutic modality for the treatment of acute respiratory failure (ARF). In this review, we critically analyze randomized controlled trials on the most used NIV interfaces in the treatments of ARF. Methods: The searches were conducted in the Medline, Lilacs, PubMed, Cochrane, and Pedro databases from June to November 2021. The inclusion criteria were Randomized clinical trials (RCTs) published from 2016 to 2021 in Portuguese, Spanish, or English and involving adults (aged ≥ 18 years). The eligibility criteria for article selection were based on the PICO strategy: Population—Adults with ARF;Intervention—NIV Therapy;Comparison—Conventional oxygen therapy, high-flow nasal cannula (HFNC) oxygen therapy, or NIV;Outcome—improvement in ARF. The search for articles and the implementation of the inclusion criteria were independently conducted by two researchers. Results: Seven scientific articles involving 574 adults with ARF due to various causes, such as chest trauma, decompensated heart failure, coronavirus disease 2019 (COVID-19), and postoperative period, among others, were included. The interfaces cited in the studies included an oronasal mask, nasal mask, full-face mask, and helmet. In addition, some favorable outcomes related to NIV were reported in the studies, such as a reduction in the rate of orotracheal intubation and shorter length of stay in the ICU. Conclusions: The most cited interfaces in the treatment of ARF were the oronasal mask and the helmet.

Bi-level Nasal Positive Airway Pressure(BiPAP)versus Nasal Continuous Positive Airway Pressure(CPAP)for Preterm Infants with Birth Weight Less Than 1500g and Respiratory Distress Syndrome Following INSURE Treatment:A Two-center Randomized Controlled Trial

The present study aimed to examine the effectiveness of bi-level positive airway pressure(BiPAP)versus continuous positive airway pressure(CPAP)in preterm infants with birth weight less than 1500 g and respiratory distress syndrome(RDS)following intubation-surfactant-extubation(INSURE)treatment.A two-center randomized control trial was performed.The primary outcome was the reintubation rate of infants within 72 h of age after INSURE.Secondary outcomes included bronchopulmonary dysplasia(BPD),necrotizing enterocolitis(NEC),retinopathy of prematurity(ROP)and incidences of adverse events.Lung function at one year of corrected age was also compared between the two groups.There were 140 cases in the CPAP group and 144 in the BiPAP group.After INSURE,the reintubation rates of infants within 72 h of age were 15%and 11.1%in the CPAP group and the BiPAP group,respectively(P>0.05).Neonates in the BiPAP group was on positive airway pressure(PAP)therapy three days less than in the CPAP group(12.6 d and 15.3 d,respectively,P<0.05),and on oxygen six days less than in the CPAP group(20.6 d and 26.9 d,respectively,P<0.05).Other outcomes such as BPD,NEC,ROP and feeding intolerance were not significantly different between the two groups(P>0.05).There was no difference in lung function at one year of age between the two groups(P>0.05).In conclusion,after INSURE,the reintubation rate of infants within 72 h of age was comparable between the BiPAP group and the CPAP group.BiPAP was superior to CPAP in terms of shorter durations(days)on PAP support and oxygen supplementation.There were no differences in the incidences of BPD and ROP,and lung function at one year of age between the two ventilation methods.

Sildenafil versus continuous positive airway pressure for erectile dysfunction in men with obstructive sleep apnea： a comparat-ive study of their efficacy and safety and the patient＇s satisfaction with treatment

Aim： To assess the efficacy of sildenafil and continuous positive airway pressure （CPAP） in the treatment of concurrent erectile dysfunction （ED） with obstructive sleep apnea （OSA）, and to gauge the level of treatment satisfaction in patients and their partners. Methods： Forty men were treated for 12 weeks with sildenafil 100 mg （20 men） or CPAP during nighttime sleep （20 men）. Treatment efficacy was assessed by the rate of successful intercourse attempts, and satisfaction with treatment was assessed by patients＇ and partners＇ answers to question 1 of the Erectile Dysfunction Inventory of Treatment Satisfaction. Results： Under sildenafil, 128 of 249 （51.4%） intercourse attempts were successful; under CPAP, 51 of 193 （26.9%） attempts were successful （^cp 〈 0.001）. Erectile function was improved in both groups. After sildenafil and CPAP treatment, the mean International Index for Erectile Function domain scores were 14.3 and 10.8, respectively （^bp = 0.025）, compared to 7.8 and 7 at baseline, respectively. CPAP and sildenafil were well tolerated. Sporadic episodes of nasal dryness under CPAP and transient headache and flushing under sildenafil were not significant. Fifty percent of patients treated with sildenafil and 25% with CPAP were satisfied with the treatment, and their partners were equally satisfied. The satisfaction scores for both patients and partners under sildenafil were superior to those under CPAP （^cP 〈 0.002）. Conclusion： Both sildenafil 100 mg and CPAP, used separately, had positive therapeutic impact but sildenafil was superior. Patients and their partners were more satisfied with sildenafil for the treatment of ED. However, because of the high proportion of dissatisfied men and partners, new therapeutic agents or a combination of the two methods must be studied further.

Impact of continuous positive airway pressure therapy for nonalcoholic fatty liver disease in patients with obstructive sleep apnea

BACKGROUND Obstructive sleep apnea(OSA)has been suggested as an independent risk factor for nonalcoholic fatty liver disease(NAFLD),and continuous positive airway pressure(CPAP)is the first-line therapy for OSA.AIM To clarify the efficacy of effective CPAP therapy on NAFLD of OSA patients by serum markers and transient elastography(TE)using FibroScan®(Echosens,Paris,France).METHODS We prospectively enrolled 123 consecutive patients with OSA who met the indications for CPAP.Liver fibrosis and steatosis were assessed using TE.Before and after 6 mo of CPAP therapy,serum markers and TE were assessed for all patients.The mean usage rate of CPAP therapy for 6 mo was arbitrarily calculated in each patient and expressed as“mean compliance index”(m-CI).RESULTS In 50 OSA patients with NAFLD,both aspartate aminotransferase(AST)and alanine aminotransferase(ALT)levels were significantly decreased after 6 mo of CPAP therapy.Univariate analysis showed that decreased body weight(BW),decreased body mass index(BMI),decreased AST level,decreased hemoglobin A1c,and high m-CI were significantly related with improved ALT level.In multivariate regression model adjusted for quantities of BW change during 6 mo of CPAP therapy,high m-CI tended to improve ALT level(P=0.051).All 17 OSA patients with NAFLD,high m-CI and no BMI changes showed significant improvements in AST and ALT levels.Meanwhile,no significant changes in TE data or serum fibrosis markers were seen.CONCLUSION Some NAFLD could be associated with chronic intermittent hypoxia due to OSA independent of BW changes.In those cases,adequate reoxygenation from effective CPAP therapy may improve NAFLD.

Relationship between intubation rate and continuous positive airway pressure therapy in the prehospital setting

BACKGROUND: To determine whether the prehospital use of continuous positive airway pressure(CPAP) therapy is associated with a reduced rate of endotracheal intubation in patients with an acute respiratory disorder brought to the emergency department(ED).METHODS: We reviewed medical records of patients with acute respiratory distress who had been treated with CPAP in the Mobile Intensive Care Unit(MICU) from January 2010 to December 2011. These records were compared with those of patients who received standardized care without CPAP in the MICU from January 2004 to December 2004. Categorical variables were summarized as frequencies and compared between groups using Fisher's exact test or the Chi-square test. Continuous variables were summarized as medians(interquartile range), and comparison between the groups was made using Wilcoxon's rank-sum test. The relationship between CPAP and intubation rate was determined using multivariable logistic regression analysis of propensity scores. The results were presented as odds ratio(OR), 95% confidence interval(CI), and P value for test effect. The adequacy of the model was calibrated using Hosmer and Lemeshow's goodness-of-fit test. P<0.05 was considered statistically significant.RESULTS: The records of 785 patients were reviewed. Of the 215 patients treated with CPAP in the MICU, 13% were intubated after admission. In contrast, of the 570 patients who did not receive CPAP, 28% were intubated after ED admission. Unadjusted logistic regression analysis showed that patients who had been treated with CPAP were less likely to be intubated than those without CPAP treatment(OR=0.37, 95% CI, 0.24–0.57, P<0.0001). With propensity scores adjusted, multivariate logistic regression analysis showed that CPAP treatment was associated with a 62% reduction of intubation(OR=0.384, 95%CI, 0.25–0.60, P≤0.0001).CONCLUSIONS: In patients with acute respiratory disorder, there was a relationship between CPAP therapy and the decreased intubation rate. CPAP therapy was feasible in prehospital management of patients with respiratory distress.

Changes in peak inspiratory flow rate and peak airway pressure with endotracheal tube size during chest compression

BACKGROUND:Adequate airway management plays an important role in high-quality cardiopulmonary resuscitation(CPR).Airway management is usually performed using an endotracheal tube(ETT)during CPR.However,no study has assessed the effect of ETT size on the fl ow rate and airway pressure during CPR.METHODS:We measured changes in peak inspiratory fl ow rate(PIFR),peak airway pressure(Ppeak),and mean airway pressure(Pmean)according to changes in ETT size(internal diameter 6.0,7.0,and 8.0 mm)and with or without CPR.A tidal volume of 500 mL was supplied at a rate of 10 times per minute using a mechanical ventilator.Chest compressions were maintained at a constant compression depth and speed using a mechanical chest compression device(LUCAS2,mode:active continuous,chest compression rate:102±2/minute,chest compression depth 2–2.5 inches).RESULTS:The median of several respiratory physiological parameters during CPR was significantly different according to the diameter of each ETT(6.0 vs.8.0 mm):PIFR(32.1 L/min[30.5–35.3]vs.28.9 L/min[27.5–30.8],P<0.001),Ppeak(48.84 cmH2O[27.46–52.11]vs.27.45 cmH2O[22.53–52.57],P<0.001),and Pmean(18.34 cmH2O[14.61–21.66]vs.13.66 cmH2O[8.41–19.24],P<0.001).CONCLUSION:The changes in PIFR,Ppeak,and Pmean were related to the internal diameter of ETT,and these values tended to decrease with an increase in ETT size.Higher airway pressures were measured in the CPR group than in the no CPR group.

Effect of Right Supine Tracheal Extubation on Respiratory Complications and Airway Pressure in the Waking Period of General Anesthesia in Pediatric Stomatology

Objective: The purpose of this study was to investigate the effect of right supine endotracheal intubation on respiratory complications and airway pressure of general anesthesia, and to provide guidance for clinical application. Methods: Seventy-two children who received oral treatment under general anesthesia from November 2020 to November 2021 in Yantai Stomatological Hospital were randomly divided into three groups, 24 cases in each group. All three groups of children entered the PACU after the surgery. The children in Group I were extubated in the supine position, the children in Group II were immediately changed to the right decubitus after extubation in the horizontal position, and the children in Group III were extubated in the right decubitus. HR, MAP and SpO2 of T1 (the time point at the beginning of surgery), T2 (the time point at 1 hour after surgery), T3 (the time point after extubation), T4 (the time point at 1 minute after extubation), T5 (the time point at 3 minutes after extubation) in the three groups were observed, t1 (operation time) and t2 (the time of leaving the PACU) were recorded. The airway pressure (P1) in the recumbent position and the airway pressure (P2) in the right decubitus position before extubation were recorded in Group III. The number of sputum suction and complications after extubation were counted. Results: The t2 in Group III was shorter than that in Groups I and II, and the number of sputum suction in Group III was less than that in Groups I and II (P < 0.05). The HR at T3, T4 and T5 in Group III was lower than that in Group I, and the HR at T4 and T5 was lower than that in Group II (P < 0.05). There were significant differences in the incidence of respiratory complications among the three groups (P < 0.05). The incidence of asphyxia, bucking and glossocoma postoperative agitation in Group III was significantly lower than that in Group I, and the incidence of asphyxia and choking was lower than that in Group II (P < 0.05). The incidence of glossoptosis in Group II was significantly lower than that in Group I (P < 0.05). In Group III, the airway pressure P2 in the right decubitus position during endotracheal intubation was higher than that of P1 in the supine position during endotracheal intubation (P < 0.05). The 95% Confidence Interval (CI) of airway pressure difference was 1.416 - 1.834 cmH2O. Conclusion: For children undergoing intraoral therapy under general anesthesia, tracheal extubation in the right decubitus position can improve the circulation fluctuation before and after extubation, reducing the number of sputum suction and respiratory tract-related complications, and can shorten the departure time. The body position change during the tracheal intubation will slightly increase the airway pressure, but the supine position after extubation can better ensure the smooth spontaneous breathing of children, which can provide the reference for clinical application.

Changes in Brachial and Central Blood Pressure after Short Term Continuous Positive Airway Pressure Treatment of Patients with Moderate-to-Severe Obstructive Sleep Apnoea and Impaired Renal Function

Background: Previous studies of continuous positive airway pressure (CPAP) treatment for obstructive sleep apnoea (OSA) have shown conflicting results on the effect on blood pressure (BP), and patients with chronic kidney disease (CKD) have not been included in these studies. As OSA is a frequent comorbidity in patients with CKD, it is of relevance to evaluate the effect of CPAP treatment on BP in this population. Aim: In this prospective follow-up study, we measured the effect of short term CPAP treatment of moderate-to-severe OSA on brachial and central BP, plasma level of syndecan-1 and vasoactive hormones, renal handling of sodium, subjective sleepiness, and quality of life in patients with impaired renal function. Methods: From December 2015 until March 2017, 25 patients were invited to participate in the study at the University Clinic in Nephrology and Hypertension, Aarhus University and Holstebro Hospital. At baseline and at follow-up after three to four months of CPAP treatment, we performed 24 h brachial and central ambulatory BP measurement, blood sampling measurements of plasma concentrations of syndecan-1, renin, angiotensin II, aldosterone, vasopressin, creatinine, haemoglobin A1c, and cholesterol, cardio respiratory monitoring, 24 h urine collection for measurement of urinary excretion of albumin, aquaporin-2, and epithelial sodium channel, Epworth Sleepiness Scale (ESS), and SF-36 (quality of life). Results: At follow-up, the 17 included patients with mean baseline estimated glomerular filtration rate 66 mL/min/1.73 m2 had a significant decrease in systolic office-, 24 h- and daytime-BP (13, 7, and 8 mmHg, respectively, p Conclusion: Short-term CPAP treatment of patients with moderate-to-severe OSA and reduced renal function decreased 24 h- and daytime-BP significantly and reduced urinary albumin excretion. Our results underline the importance of treatment of OSA in hypertensive patients with impaired renal function.

Erroneous presentation of respiratory-hemodynamic disturbances and postsurgical inflammatory responses in patients having undergone abdominal cavity cancer surgery

In this letter to the editor,the authors discuss the findings and shortcomings of a published retrospective study,including 120 patients undergoing surgery for gastric or colon cancer under general anesthesia.The study focused on perioperative dynamic respiratory and hemodynamic disturbances and early postsurgical inflammatory responses.

持续气道正压通气对睡眠呼吸暂停患者疗效及C-反应蛋白和血沉的影响

阻塞性睡眠呼吸暂停低通气综合征（OSAHS）主要表现为睡眠时打鼾并伴有呼吸暂停和呼吸表浅，夜间反复发生低氧血症、高碳酸血症和睡眠结构紊乱，导致白天嗜睡，心、脑、肺、血管并发症乃至多脏器损害，严重影响患者生活质量和寿命。OSAHS是心血管疾病的一个独立危险因素。OSAHS患者伴有炎症性过程，其体内的炎性因子可发生不同程度的改变，炎性因子改变对心脑血管疾病发病率有一定的促进作用，可通过各种机制参与血管病变。

Changes in Plasma Angiotensin II and Circadian Rhythm of Blood Pressure in Hypertensive Patients with Sleep Apnea Syndrome Before and After Treatment

Objective To explore the changes in plasma angiotensin II （Ang Ⅱ） and circadian rhythm of blood pressure among hypertensive patients with sleep apnea syndrome （SAS） before and after continuous positive airway pressure （CPAP） or surgical treatment. Methods A total of 180 essential hypertension patients were enrolled in our study. The determination of plasma Ang Ⅱ concentration, ambulatory blood pressure （ABP）, and polysomnography （PSG） monitoring were performed before and 3 months after CPAP or surgical treatment. Results Patients were classified into three groups by their apnea-hypopnea index （AHI）： essential hypertension group （EH group, n=72; AHI〈5）, essential hypertension with mild SAS group （EH＋mild SAS group, n=60, 5≤AHI〈20）, and essential hypertension with moderate and severe SAS group （EH＋moderate-severe SAS group, n=48, AHI_〉20）. The concentrations of plasma AngⅡ in the above three groups were 13.42±3.27, 16.17±3.82, and 18.73±4.05 ng/mL respectively before treatment, and AngⅡ concentration in EH patients combined with SAS was significantly higher than that in EH group （all P〈0.05）. After treatment the values in the latter two groups significantly decreased to 14.67±2.56 and 15.03±3.41 ng/mL respectively （P〈0.05）. The incidence of non-dipper blood pressure curve in EH patients was 31.9%, and those in hypertensive patients with mild SAS and moderate-severe SAS were 51.7% and 58.3%, respectively before treatment. The incidence of non-dipper blood pressure curve in the EH patients with mild SAS was significantly higher than that of patients with EH alone （P〈0.05）. After CPAP treatment or surgery, the incidence of non-dipper blood pressure curve in the two SAS groups was significantly decreased to 38.3% and 39.6%, respectively （P〈0.05）. Conclusions Ang Ⅱ might play a role in blood pressure variability in patients with obstructive SAS. CPAP or surgical treatment can improve blood pressure disorder and decrease plasma Ang Ⅱ level in patients with obstructive SAS.

Postoperative secondary aggravation of obstructive sleep apneahypopnea syndrome and hypoxemia with bilateral carotid body tumor:A case report

BACKGROUND Carotid body tumor(CBT)is a chemoreceptor tumor located in the carotid body,accounting for approximately 0.22%of head and neck tumors.Surgery is the main treatment method for the disease.CASE SUMMARY We reviewed the diagnosis and treatment of one patient who had postoperative secondary aggravation of obstructive sleep apnea–hypopnea syndrome(OSAHS)and hypoxia after surgical resection of bilateral CBTs.This patient was admitted,and relevant laboratory and imaging examinations,and polysomnography(PSG)were performed.After the definitive diagnosis,continuous positive airway pressure(CPAP)treatment was given,which achieved good efficacy.CONCLUSION This case suggested that aggravation of OSAHS and hypoxemia is possibly caused by the postoperative complications after bilateral CBTs,and diagnosis by PSG and CPAP treatment are helpful for this patient.

Management of non-alcoholic fatty liver disease patients with sleep apnea syndrome

Nonalcoholic fatty liver disease(NAFLD)is strongly associated with sleep apnea syndrome(SAS).Many NAFLD patients have SAS,and obstructive sleep apnea hypopnea syndrome is also considered to be an independent risk factor for NAFLD,as it contributes to the progression of NAFLD via oxidative stress,lipid peroxidation,inflammation,and insulin resistance.This review aims to provide some recommendations for the management of NAFLD patients with SAS,including diet,exercise,weight loss,and continuous positive airway pressure.This review also highlights the importance of effective strategies in NAFLD prevention and treatment.

Effect of endobronchial blocker tube in the pulmonary carcinoma with video-assisted thoracic surgery

Objective:The aim of this study was to observe the effect of endobronchial blocker tube in the pulmonary carcinoma with video-assisted thoracic surgery.Methods:Forty patients of pulmonary carcinoma with video-assisted thoracic surgery were randomly assigned into two groups with twenty cases each:endobronchial blocker tube group(group 1) and double-lumen endobronchial tube group(group 2).After anesthesia was induced,in group 1,single lumen tube was intubated at first,and then endobronchial blocker tube intubated to left or right primary bronchus under the guidance of fiber-optic bronchoscope according to operational necessary,injected 2-4 mL air to blocker balloon and blocker one lateral primary bronchus for one-lung ventilation necessarily;while in group 2,the position of double-lumen endobronchial tube was confirmed with fiber-optic bronchoscope after intubation.Blood samples were collected before anesthesia induction,double lumen ventilation,at the one-lung ventilation of 5 min,30 min,60 min,120 min and 180 min,SBP,DBP,HR,SpO2,partial pressure of end tidal carbon dioxide(PetCO2),pH,PaO2,PaCO2,PaO2/FiO2 were recorded.Results:Forty cases' intubations were all successful.There were no differences in SBP,DBP,HR,SpO2,PetCO2,pH,PaCO2 between two groups in different points(P > 0.05).Paw in group 1 was lower than group 2,PaO2 and PaO2/FiO2 in group 1 was higher than group 2 in the one lung ventilation of 5 min,30 min,60 min,120 min and 180 min.Conclusion:The endobronchial blocker tube can meet the request of video-assisted thoracic surgery,with the special advantages of simple insertion,lower airway and better oxygenation.Endobronchial blocker tube offer a new way for one-lung ventilation in the pulmonary carcinoma with video-assisted thoracic surgery.