Fluoroscopic-guided extraluminal placement of pediatric endobronchial blocker for lung isolation for thoracotomy in a small child: A case report

One lung ventilation (OLV) is essential for adequate visualization and surgical exposure for thoracic surgeries. However, it is challenging in small children due to limited choice of instruments and anatomical and physiological differences of airway from adults. A4-year-old male child (weight: 12 kg, height: 95 cm) presented with fever with chills and breathing difficulty for one month. Contrast-enhanced computed tomography (CECT) revealed loculated pleural collection in the left upper lobe with suspicion of empyema with two cavitary lesions with air-fluid level in the left upper lobe. The child was scheduled for left thoracotomy. To ensure successful OLV, we used a microcuff endotracheal tube (ETT) with a pediatric bronchial blocker placed extraluminally and parallel to ETT during laryngoscopy. The final endobronchial placement, due to the unavailability of a smaller diameter fibreoptic bronchoscope of bronchial blocker, was done by injecting a diluted iodinated dye into the bronchial blocker (BB) lumen under fluoroscopic guidance. : We performed a successful OLV using a microcuff ETT and a pediatric bronchial blocker placed under fluoroscopic guidance. The surgery was completed with good lung isolation without any adverse events, such as hypoxemia or dislodgment. In case of unavailability of an appropriate sized FOB, lung isolation for thoracoscopic surgeries in small children can be done using the fluoroscopic guided placement of pediatric bronchial blocker. In case the BB does not have a radio-opaque line/marker; an iodinated dye in small and diluted amount can be used to assist BB placement in main stem bronchus.