All of the following constitute appropriate airway management for a 8 year-old
undergoing thoracotomy for right lower lobectomy EXCEPT:
a) Placement of a left-sided double-lumen endotracheal tube (confirmed by
fiberoptic bronchoscopy)
b) Placement of a standard endotracheal tube in the left mainstem bronchus
c) Placement of a bronchial blocker in the right mainstem bronchus
d) Placement of a right-sided double-lumen endotracheal tube (confirmed by
fiberoptic bronchoscopy)
e) Placement of a standard endotracheal tube in the mid-trachea
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Answer
Answer d.
Each of the options for lung-isolation for OLV are acceptable
(including mid-tracheal placement and the use of two-lung ventilation), with the
exception of a right-sided double-lumen tube (DLT). Because of the proximity of
the right-upper lobe bronchus to the carina, it is challenging to position these
tubes correctly, especially in children, and left sided DLTs are generally used for
both left- and right-side thoracotomy when possible.
Notes
- This question originally printed in the Pediatric Anesthesiology Review Topics kindle book series, and appears courtesy of Naerthwyn Press, LLC.
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