One-lung ventilation in a patient with a large mass on the glottis

Abstract

Rationale:One-lung ventilation (OLV) is required during most thoracic surgeries to facilitate surgical visualization by collapsing the lung. Double-lumen tubes and bronchial blockers are two commonly used devices for OLV; however, it may be difficult to place two devices in patients with narrow inlets, such as those that have tumor-induced airway stenosis.Patient concerns:We report the case of an adult patient with a lung tumor that was growing rapidly and hemorrhaging; thus, a thoracotomy for lung resection should have been performed as early as possible. However, a large mass on the glottis obstructed the entry of the double-lumen tube or bronchial blocker. Therefore, the operation could not be performed because of the inability to provide one-lung ventilation via the conventional intubation method.Diagnoses:Computed tomography (CT) revealed a lung tumor that was growing rapidly and preoperative bronchoscopy showed a large mass on the vocal cords.Interventions:After anesthesia induction, a Uniblocker and a small single lumen tube were intubated and the Uniblocker was inserted extraluminally of the single lumen tube. One-lung ventilation was achieved successfully in this patient.Outcomes:The surgery proceeded uneventfully for 4 hours without any complications.Lessons:Extraluminal use of the Uniblocker and a small single lumen tube may be recommended for patients receiving OLV and who have narrow inlets, especially under emergency situations.