Use of a Bronchial Blocker for One-Lung Ventilation in a Patient With Severe Airway Obstruction - A Case Report

Sep 29, 2026

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One-lung ventilation (OLV) is often needed during thoracic surgery, but severe airway obstruction can make lung isolation difficult and increase the risk of airway injury with conventional techniques such as double-lumen tubes. A case report describes a 73-year-old woman with marked tracheal stenosis from a large goiter. Because a standard DLT could not pass, OLV was achieved using a small-diameter single-lumen tube plus an intraluminal bronchial blocker placed bronchoscopically. OLV was maintained successfully without complications, suggesting a practical, less traumatic alternative for patients with severe tracheal stenosis.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages5

Reading Time13 min

AccessFree to download

Abstract

Introduction

Case Presentation

Preoperative assessment and airway evaluation

Anesthesia plan and lung isolation strategy

Review began 11/13/2025 Review ended 12/02/2025 Published 12/05/2025 © Copyright 2025 Maeda et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited. DOI: 10.7759/cureus.98554 Open Access Case Report Use of a Bronchial Blocker for One-Lung Ventilation in a Patient With Severe Airway Obstruction: A Case Report Kaori Maeda 1, Eisuke Kako 2 , MinHye So 1, Kazuya Sobue 1 1. Department of Anesthesiology and Intensive Care Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, JPN 2. Department of Advanced Medical Nursing, Nagoya City University Graduate School of Nursing, Nagoya, JPN Corresponding author: Eisuke Kako, [8isuke@gmail.com](8isuke@gmail.com) Abstract One-lung ventilation (OLV) is often required during thoracic surgery to optimize surgical exposure and ventilation. However, in patients with severe airway obstruction, establishing OLV can be challenging because conventional lung isolation techniques, such as double-lumen tubes (DLTs), carry a high risk of airway injury. We report the case of a 73-year-old woman with a large goiter who underwent robot-assisted thoracoscopic thyroidectomy. Preoperative imaging revealed severe tracheal stenosis with a minimum diameter of 3 .3 mm, precluding the use of a standard DLT. To achieve OLV with minimal airway manipulation, a single-lumen tube (SLT) with an internal diameter of 5 .5 mm was used in combination with an intraluminal bronchial blocker (BB) inserted under bronchoscopic guidance. OLV was successfully maintained throughout the procedure without complications. The use of an intraluminal BB through a small-diameter SLT may represent a practical and less traumatic alternative for achieving lung isolation inpatients with severe tracheal stenosis. Categories: Anesthesiology Keywords: airway management, bronchial blocker, difficult airway management, one-lung ventilation, thoracic surgery, tracheal stenosis Introduction A difficult airway is defined as a clinical situation in which an experienced provider encounters difficulty with one or more of the following: face mask ventilation, direct or indirect laryngoscopy, trachealintubation, supraglottic device placement, or surgical airway management [1] . Severe tracheal compression caused by an anterior cervical tumor can result in a difficult airway by obstructing airflow and compromising adequate oxygenation. When such a tumor extends into the thoracic cavity, one-lung ventilation (OLV) maybe required to provide optimal surgical exposure. However, establishing OLV in these patients is particularly challenging because no standardized method for lung isolation exists. Standard double-lumen tubes (DLTs) or bronchial blockers (BBs) may not pass through the stenotic trachea, and the use of small-diameter singlelumen tubes (SLTs) carries a risk of mucosal injury in the fragile, narrowed airway. Furthermore, manipulation of an extraluminal BB or repeated repositioning of an SLT can exacerbate airway trauma [2] . Therefore, a technique that minimizes manipulation within the stenotic segment is desirable. The intraluminal placement of a BB through a small-diameter SLT may be a safer, less invasive approach to achieve OLV in such cases. Here, we report the successful use of this technique in a patient with severe tracheal stenosis undergoing robot-assisted thoracoscopic thyroidectomy. Case Presentation A 73-year-old woman (height: 151 cm, weight: 36 kg) with a massive right-sided goiter extending from the right thyroid lobe to the middle mediastinum was scheduled for robot-assisted thoracoscopic thyroid tumor resection combined with a cervical procedure. Her medical history included ulcerative colitis treated with prednisolone. Computed tomography (CT) revealed a 103 × 54 × 41 mm goi

FAQs

Why was one-lung ventilation (OLV) required for this patient?

OLV was required to provide optimal surgical exposure during robot-assisted thoracoscopic thyroidectomy when the goiter extended toward the thoracic cavity.

Why was a standard double-lumen tube (DLT) not suitable?

A DLT was unsuitable because its outer diameter exceeded the diameter of the stenotic trachea.

How was OLV achieved despite severe tracheal stenosis?

OLV was maintained using a small-diameter single-lumen tube combined with an intraluminal bronchial blocker inserted under bronchoscopic guidance to minimize airway manipulation.

Sep 29, 2026

Uploaded by McGucket