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Mount Sinai Medical Center, One Gustave L. Levi Place, Department of Anesthesia - New York
The improvements in video endoscopic surgical equipment and a growing enthusiasm for minimally invasive surgical approaches, brought video assisted thoracoscopy (VAT) to the practice of surgery for diagnostic and therapeutic procedures. Most of these procedure required a well collapse lung and should be included in the absolute indication for one lung ventilation (OLV) category. The univent tube, is a novel means of achieving bronchial blockade. The bronchial blocker technique has been modified so that the bronchial blocker is passed along a single-lumen endobronchial tube. It was introduced to clinical practice to avoid the need to change the double lumen tube at the conclusion of the procedure. Finally, one of the most interesting future concept to keep adequate oxygenation during OLV, is the ability to modulate the lung circulation. In fact inhaled nitric oxide (NO) and intravenous Almitrine have been combined with additive effects on gas exchange. In case of OLV using that combination will maximize the HPV of the non-dependent lung while dilate the dependent lung to practically eliminate the transpulmonary shunt.