TYK186

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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