Clinical experience of one lung ventilation using an endobronchial blocker in a patient with permanent tracheostomy after total laryngectomy

Corresponding author: Hyun Kyoung Lim, M.D., Department of Anesthesiology and Pain Medicine, Inha University Hospital, 7-206, Sinheungdong 3-ga, Jung-gu, Incheon 400-711, Korea. Tel: 82-32-890-3968, Fax: 82-32-881-2475, E-mail: [email protected] This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http:// creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. CC The necessity of one lung ventilation (OLV) is increasing in various types of surgery, and double-lumen endotracheal tube (DLT), endobronchial blocker based Univent (Univent, Fuji Systems Corp., Tokyo, Japan) tube, and endobronchial blocker through single-lumen endotracheal tube or laryngeal mask airway can be used for OLV [1]. There are some patients who need OLV after tracheostomy, and in those cases, the method that can be used for lung separation is limited. Here, we report a clinical experience in which OLV with an endobronchial blocker through a single lumen reinforced wire endotracheal tube was used in a patient who needed OLV after total laryngectomy. A 64-year-old male patient was diagnosed with supraglottic cancer and had a permanent tracheostomy following a total laryngectomy in May, 2009 Treatment with chemotherapy and radiotherapy were carried out six times. Since a 7 mm sized solitary pulmonary nodule and 9.3 mm sized cavitary nodule were observed in the positron emission tomography (PET) done in April, 2010, the patient was scheduled to undergo a right upper lobectomy of the lung to treat and diagnose the metastatic cancer. He was 172 cm tall and 67.2 kg in weight. As total laryngectomy limited tracheal intubation orally, the patient had to be intubated through the stoma of the tracheostomy. We confirmed the patency and measured the size of the trachea and bronchus through the coronal and axial view of the chest CT (Fig. 1). The length and diameter of the right main bronchus was 23.38 mm and 17.40 mm, respectively. The diameter of the left main bronchus was 14.96 mm. Considering the operation site and the diameter of the left main bronchus, a 37 or 41 Fr DLT was preferred, but to avoid causing injury to the tissue around the stoma of tracheostomy and taking into consideration the angle formed by the trachea and the stoma, we decided to use a single-lumen reinforced wire endotracheal tube and endobronchial blocker (Coopdech, Coopdech, Daiken medical Co., Osaka, Japan) which is more flexible than a DLT.