title: Provision of stable lung isolation in an unstable patient: an endobronchial blocker through the Murphy eye of the in situ endotracheal tube.
abstract: Shortly after repair of a type A aortic dissection, resternotomy was required because of tamponade. During the exploration, it was discovered that the source of bleeding was in the right pleura. Collapse of the right lung was requested. A double-lumen tube would have necessitated changing the endotracheal tube (ETT) in an unstable patient in the middle of surgery. Instead, a Coopdech endobronchial blocker was passed into the right lung through the lumen of the in situ ETT. To ensure that the blocker did not migrate into the trachea, it was deliberately passed through the Murphy eye of the ETT, which had been deliberately passed distally to almost touch the carina. This arrangement provided reliable right-lung collapse to facilitate right pleural hemostasis.
authors.affiliation: Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong and Prince of Wales Hospital, Shatin, NT, Hong Kong SAR, People's Republic of China. hoamh@hotmail.com
authors.forename: Anthony M-H
authors.initials: AM
authors.lastname: Ho
authors.forename: Innes Y P
authors.initials: IY
authors.lastname: Wan
authors.forename: Randolph H L
authors.initials: RH
authors.lastname: Wong
authors.forename: Calvin S H
authors.initials: CS
authors.lastname: Ng
authors.forename: Siu K
authors.initials: SK
authors.lastname: Ng
mesh_terms: D000368:Aged; D000769:Anesthesia, Inhalation; D001024:Aortic Valve Stenosis / Q000601:surgery; D006348:Cardiac Surgical Procedures; D002305:Cardiac Tamponade / Q000209:etiology / Q000601:surgery; D006487:Hemostasis; D006801:Humans; D007431:Intraoperative Complications / Q000628:therapy*; D007442:Intubation, Intratracheal / Q000295:instrumentation* / Q000379:methods*; D008168:Lung / Q000502:physiology*; D008297:Male; D010994:Pleura / Q000473:pathology; D012086:Reoperation; D012121:Respiration, Artificial / Q000379:methods*