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Hypoxaemia during one-lung ventilation — FRCA Final MCQ

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HardCardiothoracic and Vascular AnaesthesiaHypoxaemia during one-lung ventilationFRCA Final

A 62-year-old man undergoing oesophagectomy with a left-sided double-lumen tube develops SpO2 84% during one-lung ventilation. FiO2 is 1.0, blood pressure is stable, airway pressures are unchanged, and auscultation suggests poor isolation after surgical manipulation. What is the most important next step?

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Correct answer: A — Check double-lumen tube position with fibreoptic bronchoscopy

Hypoxaemia during one-lung ventilation is commonly caused by double-lumen tube malposition, especially after positioning or surgical manipulation. The first step is to confirm and correct tube position with fibreoptic bronchoscopy while ensuring FiO2 is 1.0. Pulmonary vasodilators and CPAP may be considered later if isolation is correct. Tube position should be checked after turning and whenever oxygenation changes.

Reference: Association of Anaesthetists thoracic anaesthesia guidance; RCoA Final FRCA Syllabus 2026