title: Alternating one lung ventilation using a double lumen endobronchial tube and providing CPAP to the non-ventilated lung in a dog.
abstract: BACKGROUND
  This case report describes the anaesthetic management of exploratory thoracoscopy and alternating one lung ventilation (OLV) in a dog with a pulmonary bulla, and the application of continuous positive airway pressure (CPAP) to the non-ventilated lung for preventing and treating hypoxia.
  
  
  METHODS
  A 6-year-old, male castrated Border collie was scheduled for exploratory thoracoscopy to investigate spontaneous pnemothorax that had not resolved with repeated suction. Specific requirements for the thoracoscopy were alternating OLV to allow the surgical access to the right middle lobe and its removal, and the examination of the left hemithorax to rule out the presence of other lesions.
  
  
  METHODS
  Selective lung ventilation was performed with a double lumen endobronchial tube (DLT), inserted under endoscopic guidance. After a short period of two lung ventilation during preparation of the surgical field, alternating OLV was performed, combining CPAP, provided to the non-ventilated lung via a Mapleson D breathing system, and positive end-expiratory pressure (PEEP) applied to the ventilated lung. Left OLV occurred first and resection of the right middle pulmonary lobe was successfully performed; right OLV followed to allow the examination of the left hemithorax.
  
  
  CONCLUSIONS
  The combination of CPAP and PEEP resulted in a satisfactory intra-operative management of hypoxemia. Alternating OLV can be performed successfully by using a DLT. CPAP, commonly employed in human medicine, should be considered an important tool in the anaesthetic management of OLV in small animals.
authors.affiliation: Department of Clinical Veterinary Science, Vetsuisse Faculty, University of Berne, Berne, Switzerland.
authors.forename: Chiara
authors.initials: C
authors.lastname: Adami
authors.forename: Shannon
authors.initials: S
authors.lastname: Axiak
authors.forename: Ulrich
authors.initials: U
authors.lastname: Rytz
authors.forename: Claudia
authors.initials: C
authors.lastname: Spadavecchia
mesh_terms: D000818:Animals; D045422:Continuous Positive Airway Pressure / Q000295:instrumentation / Q000379:methods / Q000662:veterinary*; D004283:Dog Diseases / Q000601:surgery*; D004285:Dogs; D007442:Intubation, Intratracheal / Q000295:instrumentation / Q000379:methods / Q000662:veterinary*; D008297:Male; D011030:Pneumothorax / Q000601:surgery / Q000662:veterinary*; D012121:Respiration, Artificial / Q000295:instrumentation / Q000379:methods / Q000662:veterinary*