title: Anesthetic Management of Patients Undergoing Right Lung Surgery After Left Upper Lobectomy: Selection of Tubes for One-Lung Ventilation (OLV) and Oxygenation During OLV.
abstract: OBJECTIVE
  To investigate anesthesia management in patients undergoing right lung surgery after a previous left upper lobectomy (LUL) that may require special precautions since angulation of the left bronchus can hamper correct placement of a left-sided double-lumen tube (DLT), and one-lung ventilation (OLV) depending solely on the left lower lobe may lead to inadequate oxygenation.
  
  
  METHODS
  A retrospective data analysis.
  
  
  METHODS
  Single university hospital.
  
  
  METHODS
  Patients underwent right lung surgery after previous LUL.
  
  
  METHODS
  None.
  
  
  RESULTS
  Anesthesia management was investigated in 18 patients who underwent right lung surgery following LUL. All intubation procedures were performed under bronchoscopic guidance to prevent airway trauma. OLV could be achieved with a left-sided DLT in 12 patients, while tubes other than this were required in 6 patients, including a right-sided DLT (n = 3) and a bronchial blocker (n = 3). The presence or absence of remarkable bronchial angulation, characterized by a combination of a wide (>140°) angle between the trachea and left main bronchus and a narrow (<100°) angle between the left main and lower bronchi critically affected tube selections. The minimum SpO2 during OLV was 90.9±4.1%. In 2 patients, intermittent bilateral ventilation was required to treat desaturation. In all the patients, the scheduled surgery could be completed.
  
  
  CONCLUSIONS
  Extent of left bronchial angulations had a critical impact on whether or not a left-sided DLT could be used in patients undergoing right lung surgery after LUL.
authors.affiliation: Anesthesiology and Pain Clinic. Electronic address: ikawago@juntendo.ac.jp.
authors.forename: Izumi
authors.initials: I
authors.lastname: Kawagoe
authors.affiliation: Anesthesiology and Pain Clinic.
authors.forename: Masakazu
authors.initials: M
authors.lastname: Hayashida
authors.affiliation: General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Suzuki
authors.affiliation: General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan.
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Kitamura
authors.affiliation: General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan.
authors.forename: Shiaki
authors.initials: S
authors.lastname: Oh
authors.affiliation: Anesthesiology and Pain Clinic.
authors.forename: Daizoh
authors.initials: D
authors.lastname: Satoh
authors.affiliation: Anesthesiology and Pain Clinic.
authors.forename: Eiichi
authors.initials: E
authors.lastname: Inada
mesh_terms: D000368:Aged; D000732:Androstanols; D000768:Anesthesia, General / Q000379:methods*; D018686:Anesthetics, Intravenous; D005260:Female; D006801:Humans; D008168:Lung / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D003473:Neuromuscular Nondepolarizing Agents; D061810:One-Lung Ventilation / Q000379:methods*; D010100:Oxygen / Q000008:administration & dosage*; D010880:Piperidines; D015742:Propofol; D000077208:Remifentanil; D012189:Retrospective Studies; D000077123:Rocuronium
chemical_list: D000732:Androstanols; D018686:Anesthetics, Intravenous; D003473:Neuromuscular Nondepolarizing Agents; D010880:Piperidines; D000077208:Remifentanil; D010100:Oxygen; D000077123:Rocuronium; D015742:Propofol
keywords: anesthetic management; bronchial angulation; one-lung ventilation (OLV); post-left upper lobectomy patient