Laryngeal mask combined with bronchial tube achieves one-lung ventilation for transthoracic oesophagectomy

Laryngeal mask combined with bronchial blocker provides an alternative for lung isolation but lacks adequate access to the non-dependent lung. Substituting the blocker with a bronchial tube may overcome this limitation. In this report, a #4.5 cuffed bronchial tube was introduced into the non-dependent lung through a second-generation laryngeal mask for transthoracic oesophagectomy. During the 2.5-hour thoracotomy, one-lung ventilation was achieved by isolating the left lung with the bronchial tube and ventilating the right lung via the laryngeal mask, using volume-control mode (7 mL/kg × 12/min) with PIP21–23 cm H2O, pH 7.36 and PaCO2 38.3. Prior to thoracotomy closure, suction and reinflation of the left lung were performed through the bronchial tube. Bronchoscopy via the laryngeal mask revealed no injury to the airway after removal of the bronchial tube. The case shows that laryngeal mask combined with bronchial intubation provides one-lung ventilation with access to the isolated lung.

An anaesthesiologists concern in a patient with posterior mediastinal mass

Large mediastinal masses may cause life threatening cardiorespiratory collapse depending on their location. An 18 years old female underwent ganglioneuroma excision. She had a 15×9.4×9.1 cm left sided cervico-thoracic mass surrounded by major blood vessels with mild encasement of left vertebral artery and left subclavian artery. After placing thoracic epidural, mask ventilation was confirmed with sevoflurane induction, and succinylcholine was given for intubation. Invasive monitoring of blood pressure was obtained with intravenous access in upper and lower limbs. For lung isolation, coopdech bronchial blocker was inserted into left main bronchus. Intraoperatively she was maintained on atracurium infusion, sevoflurane in oxygen air mixture. With a left hemiclamshell incision, mass was carefully separated from surrounding blood vessels and removed en bloc. After surgery patient was extubated and shifted to intensive care unit for observation. Patient was pain free and comfortable. Though our patients anaesthesia management and surgery was uneventful, we would like to discuss the potential complications that may arise with posterior mediastinal tumours as there are few articles discussing about the anaesthetic management of posterior mediastinal tumours.