Double-lumen endotracheal tube for one-lung ventilation through a fresh tracheostomy stoma: a case report

For one-lung ventilation in many surgical cases, double-lumen endotracheal tubes are the first-line choice for airway management. For most cases, double-lumen endotracheal tubes are faster, easier to place, cheaper, and less prone to malposition than today's bronchial blocker devices. This report describes an elective tracheostomy and the use of a double-lumen endotracheal tube directly through the fresh stoma site for a 55-year-old man with a known difficult airway who had undergone a left-sided radical neck dissection and postoperative radiation 10 years earlier. The 11-hour operation, in supine and lateral positions, occurred uneventfully. This report documents one-lung ventilation of a 4-hour duration using a double-lumen endotracheal tube directly through a fresh tracheostomy site without supplemental continuous positive airway pressure to maintain an oxyhemoglobin saturation of more than 97% as measured by pulse oximetry. During the past decade, unique modifications of the use of bronchial blockers and their use with tracheostomies have been reported. Complications have been reported with double-lumen endotracheal tubes and with more recent classic and modified uses of the bronchial blockers. This article discusses appropriate preoperative patient selection and intraoperative airway management plans for the modified use of one-lung anesthesia airway devices with an emphasis on use with tracheostomies.