One‐lung ventilation when intubation is difficult – presentation of a new endobronchial blocker

Background: One‐lung ventilation utilizing a double‐lumen endotracheal tube may be technically difficult or inappropriate in morbidly obese or critically ill patients. In patients requiring awake fiberoptic intubation, double‐lumen tube placement may be impossible. Wire‐guided endobronchial blockade through a conventional endotracheal tube is a new alternative for these patients. Methods: A 44‐year‐old, 133 kg female patient was scheduled to undergo a thoracotomy for transthoracic fundoplication. A wire‐guided endobronchial blocker (WEB) was placed following rapid‐sequence induction and intubation with an 8.0 OD single‐lumen endotracheal tube with the aid of a pediatric bronchoscope. Results: The WEB, using a guiding loop, was placed with ease and allowed effective one‐lung ventilation. Conclusion: The WEB system allows one‐lung ventilation to be achieved with a conventional endotracheal tube. The need for reintubation at the end of surgery is eliminated and endotracheal tube cross‐sectional area is conserved.