Use of a Bronchial Blocker for One-Lung Ventilation in a Patient With Severe Airway Obstruction: A Case Report

TL;DR

A bronchial blocker was successfully used for one-lung ventilation in a patient with severe airway obstruction during surgery.

Contribution

The study presents a novel approach using a bronchial blocker with a small-diameter tube for lung isolation in patients with severe tracheal stenosis.

Findings

A bronchial blocker was successfully used in combination with a single-lumen tube for one-lung ventilation.

The technique avoided airway injury in a patient with a tracheal diameter of 3.3 mm.

This approach may serve as a less traumatic alternative for lung isolation in patients with severe airway obstruction.

Abstract

One-lung ventilation (OLV) is often required during thoracic surgery to optimize surgical exposure and ventilation. However, in patients with severe airway obstruction, establishing OLV can be challenging because conventional lung isolation techniques, such as double-lumen tubes (DLTs), carry a high risk of airway injury. We report the case of a 73-year-old woman with a large goiter who underwent robot-assisted thoracoscopic thyroidectomy. Preoperative imaging revealed severe tracheal stenosis with a minimum diameter of 3.3 mm, precluding the use of a standard DLT. To achieve OLV with minimal airway manipulation, a single-lumen tube (SLT) with an internal diameter of 5.5 mm was used in combination with an intraluminal bronchial blocker (BB) inserted under bronchoscopic guidance. OLV was successfully maintained throughout the procedure without complications. The use of an intraluminal BB through a small-diameter SLT may represent a practical and less traumatic alternative for achieving lung isolation in patients with severe tracheal stenosis.

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