• HoAnthony M HAMHQueen's University, Kingston General Hospital, Department of Anesthesiology and Perioperative Medicine, Kingston, Ontario, Canadá., Michael P Flavin, Melinda L Fleming, and Glenio Bitencourt Mizubuti.
• Queen's University, Kingston General Hospital, Department of Anesthesiology and Perioperative Medicine, Kingston, Ontario, Canadá.
• Braz J Anesthesiol. 2018 May 1; 68 (3): 318-321.

BackgroundSelective neonatal left mainstem bronchial intubation to treat right lung disease is typically achieved with elaborate maneuvers, instrumentation and devices. This is often attributed to bronchial geometry which favors right mainstem entry of an endotracheal tube deliberately advanced beyond the carina.Case SummaryA neonate with severe bullous emphysema affecting the right lung required urgent non-ventilation of that lung. We achieved left mainstem bronchial intubation by turning the endotracheal tube 180° such that the Murphy's eye faced the left instead of the right, and simulated a left-handed intubation by slightly orientating the endotracheal tube such that its concavity faced the left instead of the right as in a conventional right-handed intubation.ConclusionUrgent intubation of the left mainstem bronchus with an endotracheal tube can be easily achieved by recognizing that it is the position of the endotracheal tube tip and the direction of its concavity that are the chief determinants of which bronchus an endotracheal tube goes when advanced. This is important in critically ill neonates as the margin of safety and time window are small, and the absence of double-lumen tubes. Use of fiberoptic bronchoscope and blockers should be reserved as backup plans.Copyright © 2017 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

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