To the Editor,
We present an alternative to a blocker when one-lung ventilation is required.
A 62-year-old patient (American Society of Anesthesiologists (ASA) status 3), 176 cm tall, weighing 74 kg, and having tracheostomy for 6 months, was scheduled for right video-lobectomy. The diameter of the Carlens tube was chosen according to the diameter of the tracheocutaneous hole in tracheotomy. While the patient was awake the speaking cannula was replaced by a Montandon tube, and then general anesthesia was induced. After induction, with sufficient oxygenation, the Montandon tube was removed and a Carlens tube (Rusch; number 35) was introduced through the tracheostomy without a rigid guide to avoid trauma to the trachea. Tracheal and bronchial balloons were inflated and auscultation was performed to guide correct placement. The placement was successful after the first attempt and was confirmed by fluoroscopy (Fig. 1). The Carlens tube was then fixed and the patient was turned to the lateral position. The perioperative collapse of the lung was assessed by a surgeon who considered it perfect, and no movement or displacement of the Carlens tube was noticed during the surgical procedure. Placement of the Carlens tube and its control by fluoroscopy lasted for 10 minutes.
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The use of a bronchial blocker would have been the classical alternative,1 but it is associated with certain problems.
The use of a fiberscope for positioning the blocker requires a certain expertise of the anesthesiologist. Aspiration through the blocker is almost impossible because the suction channel is extremely narrow and in patients with emphysema deflation of the excluded lung is difficult.
Implementation of a blocker needs longer time and is more expensive than a double lumen tube.
We suggest the use of a Carlens tube instead of a bronchial blocker in patients with tracheostomy, which is also supported by some cases reported in the literature.2, 3