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Chapter 17 - Lung Isolation in Patients With a Difficult Airway in Thoracic Anesthesia
Book chapter

Chapter 17 - Lung Isolation in Patients With a Difficult Airway in Thoracic Anesthesia

Javier H. Campos
Cohen’s Comprehensive Thoracic Anesthesia, pp.240-248
Elsevier Inc
2022
DOI: 10.1016/B978-0-323-71301-6.00017-2

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Abstract

Patients who present with a difficult airway and require one-lung ventilation represent a challenge for the anesthesiologist. During the preoperative period, review of the posterior-anterior chest radiograph is necessary to measure the tracheal width and appreciate the pattern of the tracheobronchial anatomy to determine what device and size to use. Also a multidetector computed tomography scan of the thorax, with particular interest in tracheobronchial anatomy, must be reviewed as part of the preoperative assessment. The left-sided double-lumen tube is the most common device used for lung isolation because of its greater margin of safety. The use of bronchial blockers is indicated in patients who present with difficult airways and require lung isolation. Patients with a tracheostomy in place requiring lung isolation are best managed with the use of an independent bronchial blocker and flexible fiberoptic bronchoscopy. Flexible fiberoptic bronchoscopy is the recommended method to achieve optimal position of lung isolation devices, first in supine position, later in lateral decubitus, or whenever a malposition occurs.
 bronchial blockers double-lumen endotracheal tubes flexible fiberoptic bronchoscopy lung separation multidetector computer tomography scan of chest preoperative assessment upper and lower airway abnormalities

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