The degree of nociceptive afferentation and, consequently, the shock level of the operation is determined not only by the intensity of pain impulses from the area of ​​intervention, but also by the state of oxygen balance. Hypoxia reduces the threshold of pain sensitivity and, in addition, causes a powerful additional flow of impulses from the periphery, followed by disorganization of the work of the regulation centers and corresponding violations of compensatory processes at various times after the operation.

With extended and combined pulmonary resections, the likelihood of hypoxia is very high. Refusal from the use of inhalation anesthetics (primarily nitrous oxide), timely, in accordance with the stages of the operation and indicators of gas balance, the change in oxygen content in the breathing mixture, parameters and mechanical ventilation contour reduces the frequency and severity of hypoxia episodes, but does not exclude them, especially if the lumen of the respiratory tract is opened or occluded by pathological contents — blood, mucus, pus, detritus, a particle of the tumor. In such a situation, prevent ventilation problems help

special methods of intubation and mechanical ventilation, which, despite their diversity, usually provide for isolation of the lung affected by the pathological process or its part with separate ventilation of the lungs or with complete shutdown of the operated lung from breathing.

The choice of method is largely determined by the location and extent of the tumor, as well as the expected amount of intervention. Therefore, all possible variants of intubation and methods of mechanical ventilation should be necessarily discussed with the surgeon even before the operation.

In patients with a large number of pathological discharge in the lumen of the bronchi (paracancrosis destruction, disintegration of tumor tissue) the most reliable way to protect the tracheobronchial tree is endobronchial occlusion. During the operation in the clinic, in different periods of activity, various bronchoblocker designs — Medjil, Smetanin, Vernon-Thompson, Sipchenko — and more complex in structure — combined opacifiers, representing various combinations of bronchoblockers and endotrial tubes — Wellness, Gordon— Green and some others. Due to the lack of reliable methods of fixation and increased risk of displacement, these devices have not been used in recent years,using in such situations the method of endobronchial occlusion developed in the clinic using a foam seal.

Directly on the operating table after introductory anesthesia and rehabilitation of the tracheobronchial duur, through the Friedel respiratory bronchoscope under visual control, an obturator is introduced into the lumen of the bronchus of the affected lung area distal to the site of the intended resection — a round piece of fibrous foam. The diameter of the filling should be 2–3 times greater than the cross-section of the bronchus, which prevents the obturator from moving when the lung is inspected and the root elements are processed. After performing the bronchoscopy, the usual endotracheal intubation is performed and the conventional ventilator is performed with an oxygen-air mixture in the mode of moderate hyperventilation (120% of the calculated value). During the resection of the lobe, the bronchus is crossed proximal to the location of the filling and is removed along with the preparation.

One of the main advantages of such a blockade, which other methods do not possess, is the ability to protect healthy parts of the lung on the affected side. Only when the pathological process is localized in the upper lobe, when it is impossible to perform isolated occlusion of the upper lobe bronchus, we are forced to obtrude the main bronchus at the level of the upper lobe. For this purpose, a foam seal is sewn, stitched with a polyester filament, the end of which is removed through an endotracheal tube. After crossing the upper lobe bronchus and removing the drug, the seal is removed through the lumen of the tube using a thread. A similar technique is used for resections of the lower lobe in cases of high discharge of the sixth segmental bronchus. After crossing the inferior bronchus and separate processing of the sixth segmental bronchus, the seal is removed.

If, due to the anatomical features of the tracheobronchial tree structure and tumor localization, it is not possible to perform occlusion, as well as in the absence of absolute indications for its use, it is possible to protect the tracheobronchial tree and prevent ventilation disorders when opening the airway lumen by performing endobronchial intubation. At the same time, modern double-lumen polyvinyl chloride tubes, which do not have a “spur,” are often preferable, often, especially with a small glottis or its deep location, which makes intubation difficult and even dangerous. Moreover, when performing right-sided pneumonectomies before flashing

The bronchus tube must be tightened to prevent spurs from entering the suture. At this point, it is possible to throw a pathological discharge into the healthy lung, which usually accumulates in the bronchus over the cuff. Therefore, Carlens type tubes for right-side resections are practically not used.

On the other hand, when using left-sided interventions Bryce-Smith and Salta double-tube tubes are preferred. Due to the structural features of the tracheobronchial tree, a small “spur” located in the keel area of ​​the trachea bifurcation does not interfere with the operation, including limited resections of the mouth of the left main bronchus and the wall of the trachea. At the same time, with “blind” intubation, the “spur” allows one to more reliably fix the tube in the correct position, preventing its displacement in the distal direction with the blockade of the right upper lobe bronchus. Of course, even in this case all the shortcomings of the double-lumen tubes remain, which increase the resistance to gas flow, are easily blocked by blood clots and mucus, limit the possibility of endoscopic sanation, but do not completely eliminate ventilation problems when the pathological contents get in and healthy lung sections.The latter circumstance is usually associated with the incorrect position of the tube, which occurs in 25% of the intub blindly .