Flow-controlled One-lung Ventilation During Carinal Sleeve Reconstruction: Anaesthetic Management and Technical Feasibility.

Abstract

Carinal sleeve resection with reconstruction represents one of the most challenging thoracic surgical procedures and requires meticulous anaesthetic management to maintain adequate gas exchange within a shared and surgically interrupted airway while preserving an unobstructed surgical field. Conventional ventilation strategies, including cross-field ventilation and high-frequency jet ventilation, may interfere with surgical exposure or result in unstable ventilation. We describe the anaesthetic management of a 64-year-old male patient in whom flow-controlled ventilation- one-lung ventilation (FCV-OLV) was employed during carinal sleeve lobectomy with reconstruction. Following initial double-lumen tube ventilation, FCV was established using a Tritube^® connected to an Evone^® ventilator and maintained throughout airway reconstruction. Ventilation was achieved without interruptions, apneic periods, or cross-field ventilation. Oxygenation and carbon dioxide elimination remained stable during 180 minutes of FCV, while the small-lumen tube provided optimal surgical exposure. The patient was extubated uneventfully at the end of surgery and experienced an uncomplicated postoperative course. This case highlights the feasibility of flow-controlled OLV as an anaesthetic strategy during complex airway reconstruction. FCV-OLV enabled uninterrupted ventilation, stable gas exchange, and excellent surgical conditions without the need for extracorporeal support or alternative ventilation techniques.