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Right-Sided DLT Positioning — FRCA Final MCQ

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HardCardiothoracic AnaesthesiaRight-Sided DLT PositioningFRCA Final

A patient undergoing one-lung ventilation for a left thoracotomy has a right-sided double-lumen tube in situ. After the bronchial limb and cuff position have been assessed through the tracheal lumen, a fibreoptic bronchoscope is passed through the bronchial lumen. Which sequence of views best confirms correct depth and rotational alignment of the bronchial limb?

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Correct answer: D — Right middle- and lower-lobe orifices distally, then the right upper-lobe orifice aligned through the ventilating side slot

A correctly positioned right-sided DLT extends into the bronchus intermedius, so the distal bronchial-lumen view should show the bronchial carina separating the right middle- and lower-lobe bronchi. As the bronchoscope is withdrawn and directed towards the dedicated right-upper-lobe ventilating side slot, the right upper-lobe bronchial orifice should be aligned with and visible through that slot. This prevents inadvertent right-upper-lobe obstruction. The left main bronchus or tracheal carina should not be seen beyond the bronchial lumen. The right upper-lobe bronchus should be viewed through the side slot rather than directly beyond the distal tip. Bronchial-cuff herniation over the tracheal carina is assessed through the tracheal lumen, not through the bronchial lumen.

Reference: Li J et al. Combination of computed tomography measurements and flexible video bronchoscope guidance for accurate placement of the right-sided double-lumen tube: a randomised controlled trial, bronchoscopy-guided intubation section. BMJ Open. 2023;13:e066541. https://bmjopen.bmj.com/content/13/11/e066541