CME Module 13: Management of One-Lung Ventilation  Next >


Case Synopsis

A 67 year old male with mild emphysema (FEV1 = 62% predicted) was scheduled for a video-assisted (VATS) left upper lobectomy for an adenocarcinoma (see fig. 1). Except for a 40 pack year history of smoking, his past medical history was unremarkable. Preoperative blood work and EKG were within normal limits.

Figure 1 

Figure 1: On the left is a chest X-ray of the patient with an adenocarcinoma of the left upper lobe. On the right is a diagram of the intra-operative airway management with a left-sided double-lumen tube.

Following the induction of general anesthesia, a left-sided double-lumen tube (DLT) was inserted (see fig. 1) and the position confirmed by fiberoptic bronchoscopy. The patient was then placed in the right lateral decubitus position and right-sided one-lung ventilation (OLV) was commenced with a tidal volume of 6 ml/kg, respiratory rate 10/min and FiO2 of 0.5 in air. Anesthesia was maintained with I MAC sevoflurane.

After the insertion of the VATS telescope the surgeon complains that the lung is not well well collapsed. What should the anesthesiologist do now?

1. Reassess the position of the DLT.   
    True  or  False 

2. Apply suction to the left lung.   
    True  or  False 

3. Maintain oxygenation using a 50% mixture of air and oxygen.   
    True  or  False 


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