A Unique Strategy for Lung Isolation During Tracheobronchoplasty.

TRACHEOBRONCHOMALACIA (TBM) IS A CONDITION that consists of excessive weakening of the walls of the trachea and bronchi causing collapse of the airway with expiration. 1 Nuutinen J. Acquired tracheobronchomalacia. Eur J Respir Dis. 1982; 63: 380-387 PubMed Google Scholar The integrity of the posterior and anterior cartilaginous rings is lost, leading to dynamic obstruction. 2 Loring S.H. O’Donnell C.R. Feller-Kopman D.J. et al. Central airway mechanics and flow limitation in acquired tracheobronchomalacia. Chest. 2007; 131: 1118-1124 Abstract Full Text Full Text PDF PubMed Scopus (77) Google Scholar Patients with TBM present with life-altering symptoms such as dyspnea on exertion, cough, and occasionally hemoptysis. 3 Wilkey B.J. Alfille P. Weitzel N.S. et al. Anesthesia for tracheobronchial surgery. Semin Cardiothoracic Vasc Anesth. 2012; 16: 209-219 Crossref PubMed Scopus (12) Google Scholar Surgical correction via tracheobronchoplasty (TBP) involves external splinting of the collapsing sections of the tracheobronchial tree, thereby increasing the airway diameter and providing symptom relief (Fig 1). The surgical approach is through a right thoracotomy. It is important to note that the surgical procedure does not involve opening trachea or bronchi; thus, the airway remains intact. Airway management is complicated by the requirement for initial right-lung deflation without any device in the right main bronchus and subsequent right-lung deflation without any device in the left main bronchus. A left-sided or right-sided double-lumen tube cannot be used because a large-diameter tube inhibits reconstruction of the distal trachea.