Lung separation in the patient with a difficult airway

During video-assisted thoracoscopy the lungs should be well collapsed to allow the surgeon an optimal view of the surgical field. The use of 'difficult tubes' such as the double lumen tube or Univent cannot be avoided despite the presence of a difficult airway. If it is only possible to place a single lumen tube, a tube exchanger can be used to switch to a double lumen tube or a Univent tube. Alternatively, a Fogarty embolectomy catheter can be passed down the single lumen tube as an independant bronchial blocker. The Bullard and the Wu laryngoscopes and the laryngeal airway mask can further assist in establishing an airway. Finally, depending on the extent and the length of the procedure, an airway, initially not classified as difficult, may become difficult and postoperative planning is a must.