Thoracic Anesthesia Pearls

DLT Sizing

Females 160cm 35F or 37F Males 170cm 39F or 41F

Alternative Method for Going from One to Two Lung Ventilation

Switch clamp to good lung without dropping it in order to apply high pressure to inflate down lung without over distending good lung.

Right vs Left sided DLT Selection

• Right DLT Needed:
  • Pulmonary resection , left sided pneumonectomy/left main bronchial surgery
  • Lung transplantation, left single
  • Discuss with team

Troubleshooting Hypoxia

1. FiO2 is 100%
2. Check position with fiber optic
3. Optimize CO
4. Recruitment maneuver of ventilated lung with surgeon communication
5. Apply PEEP to ventilated lung, careful in COPD
6. Apply CPAP 1-2cm H2O to nonventialted lung. Use recruitment maneuver first. Communicate with surgeon as this may not be possible in VATs
7. Intermittent reinflation of nonventilated lung. COMMUNICATE with surgeon
8. Partial ventilation of non ventilated lung
   1. Segmental oxygen insufflation via fiber optic
   2. Lobar reinflation
   3. Lobar collapse
   4. Oxygen insufflation
   5. High frequency ventilation
9. Mechanical restriction of nonventilated lung pulmonary blood flow
   • ie. clamp the PA