Anesthetic Management for the Retrieval of Retained Intrathoracic Foreign Bodies Adjacent to Critical Mediastinal Structures Using One-Lung Ventilation With a Bronchial Blocker: A Report of Two Cases

Retained intrathoracic metallic foreign bodies (FBs) following penetrating chest trauma represent a challenging surgical emergency, particularly when situated in proximity to critical mediastinal structures. Anesthetic management in such cases demands meticulous airway planning, expertise in lung isolation techniques, and vigilant anticipation of physiological changes during one-lung ventilation. We describe two adult men with penetrating chest trauma and retained metallic FBs adjacent to critical mediastinal structures, both managed under general anesthesia with left lung isolation using a bronchial blocker (BB). The first patient, a 40-year-old factory worker, sustained an injury from an iron nail ejected from an industrial sewing machine, resulting in a retained left paratracheal FB and ipsilateral hemopneumothorax. Despite preexisting chronic obstructive pulmonary disease, the nail was successfully retrieved via video-assisted thoracoscopic surgery. The second patient, a 34-year-old man, sustained a gunshot wound with a bullet lodged in the superior mediastinum, abutting the left brachiocephalic vein; the bullet was successfully retrieved via open thoracotomy. In both cases, the airway was secured via video laryngoscopy-guided tracheal intubation with a single-lumen tube, followed by fiberoptic-guided placement of the BB in the left main bronchus. Both FBs were retrieved without injury to adjacent structures. Both patients underwent planned postoperative mechanical ventilation and subsequently recovered uneventfully. These cases highlight the utility of a sequential airway strategy, in which the airway is secured first, and a bronchial blocker is subsequently deployed to facilitate the safe retrieval of deeply situated intrathoracic FBs across differing surgical approaches. They underscore the necessity of individualized anesthetic planning, tailored lung-isolation device selection, and vigilant intraoperative monitoring in complex thoracic trauma.