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One-Lung Ventilation Technique — FRCA Final MCQ

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ModerateCardiothoracic AnaesthesiaOne-Lung Ventilation TechniqueFRCA Final

A correctly positioned left-sided double-lumen tube is being used during a right-sided thoracotomy. The pleural cavity has been opened, and the surgeon requests collapse of the right lung while ventilation of the left lung continues. Which action should be performed?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: E — Stop ventilation through the tracheal lumen and open that lumen to atmosphere

With a correctly positioned left-sided double-lumen tube, the bronchial lumen ventilates the left lung and the tracheal lumen communicates with the right lung. To commence left one-lung ventilation after pleural opening, ventilation through the tracheal lumen is stopped and its patient-side lumen is opened to atmosphere. Elastic recoil then produces rapid passive venting of the operative right lung, followed by slower absorption atelectasis. Leaving the tracheal lumen occluded may be useful before pleural opening to prevent ambient-air entrainment, but does not permit the requested immediate passive venting. Disconnecting or suctioning the bronchial lumen would collapse or impair ventilation of the dependent left lung. Additional tracheal-cuff inflation neither selects the correct lung nor initiates one-lung ventilation and risks excessive cuff pressure.

Reference: Ashok V, Francis J. A practical approach to adult one-lung ventilation. BJA Education. 2018;18(3):69–74, Figure 3. https://pubmed.ncbi.nlm.nih.gov/42452539/