Thoracic Anesthesia – Anesthesia for Special Operations

00:06 We're now going to move to Thoracic Anesthesia. And this is one of the most challenging areas of Anesthesiology. It's also potentially one of the most dangerous areas. And the reason for this is, when a surgeon is going to remove a portion of lung because of tumor, or abscess, or any other reason whatsoever, the anesthesiologist has to provide one-lung anesthesia.

00:36 We need to provide ventilation of one lung while allowing the surgical side to deflate and remain quiet and immobile for the surgeon to do his or her job on it.

00:48 This is very challenging because some of these patients, particularly more elderly patients with lung cancers, have very bad lungs. And we have to ventilate them with one lung in a situation where they've got a bad lung that's being operated on, and you're working with a bad lung and try to keep them going with that bad lung. And it's, it can be very challenging.

01:12 So, the endotracheal tube that we commonly use for things like general surgery, orthopedic surgery, etc. is replaced in thoracic surgery by the tubes that you can see in the diagram.

01:24 These are endobronchial tubes. The tube nearest to me is a right sided endobronchial tube. And because the right mainstem bronchus is short compared to the left and the take off for the right upper lobe bronchus occurs very soon after you've passed the carina, this tube needs to be specially designed to allow gas to go through a hole that's created in the distal cuff that allows one to ventilate the right upper lobe. The left side is somewhat easier, because the left mainstem bronchus is shorter than the, excuse me, longer than the right mainstem bronchus, so there's more room to place a tube in it. And you don't need the hole in the cuff to ventilate any portion of the left lung. Many anesthesiologists routinely use a left endobronchial tube for thoracic surgery and try to avoid using a right sided tube at all, because the left sided tube is just safer. There are some surgical conditions however where it's necessary to use a right sided tube. And that's when you want somebody who's really skilled at using them, because they are difficult and there's a real danger in putting them in the wrong place.