Difficult Lung Isolation – What Are the Options?

Thoracic surgeries require lung isolation and one-lung ventilation. Techniques to achieve lung isolation include double-lumen tubes (DLTs), bronchial blockers and single-lumen tubes for endobronchial intubation. However, lung isolation can be challenging in a difficult airway. Different types of airway adjuncts may be required to facilitate successful lung isolation. These airways and adjuncts have advantages, disadvantages and complications. We report a case of right-side bronchus intermedius carcinoid tumour posted for right-sided bilobectomy via a right thoracotomy, which was complicated by a difficult airway due to the presence of sharp teeth. Attempted intubation with a 39 Fr left-sided DLT ruptured the tracheal cuff due to contact with the teeth. On the second attempt, the patient was intubated with a 37 Fr left DLT under fibre-optic bronchoscope guidance. Airway adjuncts are useful in a difficult airway scenario that complies with the American Society of Anaesthesiologists difficult airway guidelines.