Right upper lobe tracheal bronchus: anesthetic challenge in one-lung ventilated patients -A report of three cases-
A 69-year-old woman, 68 kg, 147 cm, ASA physical classification status II with lung cancer, was scheduled to undergo a RUL lobectomy through a right thoracotomy approach. Leftsided OLV, using a 7.0 SLT with BB was planned. A fiberoptic bronchoscope performed prior to the insertion of a blocker showed a small RUL bronchus at the same level of the carina. It was thought that a blocker could simultaneously block the right main bronchus and RUL bronchus because the distance between them was short enough; so the blocker was tried first. After the balloon inflation with adequate volume of air, small opening proximal to the blocker cuff was still sighted under fiberoptic guidance. That opening resulted in continued ventilation of the RUL, despite the right positioning of the blocker. The blocker was withdrawn, then a left-sided, 35 F DLT was inserted to achieve complete right lung collapse.