Lung isolation for pediatric thoracic surgery is especially challenging in a patient with chronic lung infection and need to protect the nonoperative lobes from the spread of infection during anesthesia and surgery. Typically, for pediatric thoracic surgery, a mainstem intubation or placement of an intraluminal bronchial blocker is sufficient for lung isolation. The patient whose case is reported here suffered from a pleuropulmonary blastoma compressing the left lower lobe bronchus and resultant chronic infection involving the left lower lobe. In this unusual situation, to isolate the chronic lung infection and to provide the needed adequate operative conditions, endobronchial intubation of the right, nonoperative lung and placement of an endobronchial blocker into the left lower lobe bronchus were performed. Intraoperative point-of-care ultrasound was then used to confirm ventilation of the right lung segments and absence of air movement in the left upper lobe.
From the Department of Anesthesiology, Perioperative and Pain Medicine, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas.
Accepted for publication December 18, 2018.
The author declares no conflicts of interest.
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Address correspondence to Adam C. Adler, MD, MS, FAAP, FASE, Texas Children’s Hospital, Baylor College of Medicine, 6621 Fannin St, Suite No. A3300, Houston, TX 77030. Address e-mail to firstname.lastname@example.org.