• Izumi Kawagoe, Masakazu Hayashida, Kenji Suzuki, Yoshitaka Kitamura, Shiaki Oh, Daizoh Satoh, and Eiichi Inada.
• Anesthesiology and Pain Clinic. Electronic address: ikawago@juntendo.ac.jp.
• J. Cardiothorac. Vasc. Anesth. 2016 Aug 1; 30 (4): 961-6.

ObjectiveTo investigate anesthesia management in patients undergoing right lung surgery after a previous left upper lobectomy (LUL) that may require special precautions since angulation of the left bronchus can hamper correct placement of a left-sided double-lumen tube (DLT), and one-lung ventilation (OLV) depending solely on the left lower lobe may lead to inadequate oxygenation.DesignA retrospective data analysis.SettingSingle university hospital.ParticipantsPatients underwent right lung surgery after previous LUL.InterventionsNone.Measurements And Main ResultsAnesthesia management was investigated in 18 patients who underwent right lung surgery following LUL. All intubation procedures were performed under bronchoscopic guidance to prevent airway trauma. OLV could be achieved with a left-sided DLT in 12 patients, while tubes other than this were required in 6 patients, including a right-sided DLT (n = 3) and a bronchial blocker (n = 3). The presence or absence of remarkable bronchial angulation, characterized by a combination of a wide (>140°) angle between the trachea and left main bronchus and a narrow (<100°) angle between the left main and lower bronchi critically affected tube selections. The minimum SpO2 during OLV was 90.9±4.1%. In 2 patients, intermittent bilateral ventilation was required to treat desaturation. In all the patients, the scheduled surgery could be completed.ConclusionsExtent of left bronchial angulations had a critical impact on whether or not a left-sided DLT could be used in patients undergoing right lung surgery after LUL.Copyright © 2016 Elsevier Inc. All rights reserved.

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