Variations on one-lung ventilation

One-lung ventilation is a commonly used technique to facilitate surgical visualization during thoracic surgical procedures. New devices for one-lung ventilation have been introduced into clinical practice over the recent years. One such device is the Arndt Endobronchial Blocker which is a bronchial blocker with a central lumen through which a wire with a looped end has been passed. The loop on the distal end is meant to be placed over a fiberoptic bronchoscope which is then used as a guide to facilitate bronchial placement of the balloon-tipped bronchial blocker. Another advantage of the Arndt device is the airway adaptor that contains ports for the anesthesia circuit, the bronchoscope, the bronchial blocker as well as attachment to the endotracheal tube. The port for the bronchial blocker can be tightened down so as to hold the blocker in place during the procedure. However, patient issues such as size or airway alterations such as the presence of a tracheostomy may make necessary certain alterations in airway management. I describe four cases and provide suggestions for minor alterations in airway management that may be used to provide successful options for one-lung anesthesia.