[One-lung respiration in a nasally intubated patient using a single-lumen endobronchial tube]

We report the case of a 57-year-old patient who underwent a right-sided thoracotomy. The preoperative examination of the patient already revealed a clear diminution of the mouth opening (Mallampati class 4). Ventilation per mask following the induction of anaesthesia was unproblematic. As oral intubation with a double-lumen tube seemed to be impossible because of the difficult anatomic conditions, nasal intubation was carried out. For this we used a left-sided single-lumen endobronchial tube of Rüsch (size 8.0). The tube was inserted into the left mainstem bronchus using a fiberoptic bronchoscope. Intraoperatively we were able to ventilate exclusively the dependent left lung by inflating the bronchial cuff. The operation itself was performed on the collapsed right lung. At the end of the operation the right lung could be ventilated once again by deflating the bronchial cuff (tracheal cuff inflated). This example demonstrates that one-lung ventilation is possible even under difficult intubation conditions.