Intraoperative management of distal tracheal rupture with selective bronchial intubation

Patients with tracheal rupture present a considerable challenge to the anesthesiologist. The most important aspect in anesthesiology in such cases is to maintain oxygenation and ventilation without compromising surgical repair. We report a case of a woman who suffered a chemical perforation of the carina and left bronchus after ingesting hydrochloric acid during a suicide attempt. We describe the intraoperative management strategies, with emphasis on the use of bilateral bronchial intubation to provide selective lung ventilation. Alternative modes of ventilation and the use of cardiopulmonary bypass are discussed.