Anaes · Thoracic anaesthesia
Lung isolation: double-lumen tubes and bronchial blockers
Also known as Double-lumen tube · Bronchial blocker · Lung isolation · Left-sided DLT · Arndt blocker
Fellowship-level lung isolation: exact adult DLT sizing, left versus right DLT margin of safety, bronchial blocker types and indications, fibreoptic confirmation, and crisis management for malposition.
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Target exams
Red flags
- Confirm every DLT and bronchial blocker with fibreoptic bronchoscopy before and after positioning.
- Left-sided DLT preferred for most cases — greater margin of safety than right-sided DLT.
- Adult starting sizes: females approximately 35 Fr, males approximately 37 Fr (range 26–41 Fr).
- Bronchial blockers require single-lumen tube ID at least 7.5 mm in adults.
- Malposition is the leading fixable cause of hypoxaemia on one-lung ventilation.
Meet the patient
A 160 cm woman is listed for a right upper lobectomy. Which tube do you choose, what size, and how do you confirm it? The examiner will not accept "I put in a double-lumen tube" — they want the device, the number, and the bronchoscope — taught conventional sizing refined by tracheal width, with step-by-step confirmation.[1][2]
Three questions frame the topic: left or right? (left, almost always), what size? (about 35 French in this woman), and how do I prove it? (fibreoptic landmarks before and after turning lateral). Hold those three and the malposition drill slots in behind them.[1][2]
References4ShowHide
- [1]Brodsky JB et al. Tracheal diameter predicts double-lumen tube size: a method for selecting left double-lumen tubes. Anesthesia and Analgesia, 1996.PMID 8615510
- [2]Brassard CL et al. Step-by-step clinical management of one-lung ventilation: continuing professional development. Canadian Journal of Anesthesia, 2014.PMID 25389025
- [3]Karzai W, Schwarzkopf K. Hypoxemia during one-lung ventilation: prediction, prevention, and treatment. Anesthesiology, 2009.PMID 19417615
- [4]Campos JH et al. Lung isolation techniques for patients with difficult airway. Curr Opin Anaesthesiol, 2010.PMID 19752725