1. Indications for OLV may be categorized as absolute and relative (Table 37-5: Indications for One-Lung Ventilation).
2. Methods of Lung Separation
   1. Double-lumen endobronchial tubes are the most widely used means of achieving lung separation and OLV. Lung separation is achieved by inflation of two cuffs (a proximal tracheal cuff and a distal bronchial cuff located in the main stem).
   2. Because the left main bronchus is considerably longer than the right bronchus, there is a narrow margin of safety on the right main bronchus, with potentially a greater risk of upper lobe obstruction whenever a right-sided double-lumen tube (DLT) is used. A left-sided DLT is preferred for both right- and left-sided procedures.
   3. Tracheal and bronchial dimensions can be also directly measured from the chest radiograph or chest CT scan. (Correlation between patient height and airway size is poor.) Typically, most women will need a 37-Fr DLT, and most men will be adequately managed with a 39-Fr DLT.
   4. The common practice of fiberoptic bronchoscopy has lessened the risk of undetected distal placement or migration of the bronchial tip. The depth required for insertion of the DLT correlates with the height of the patient. For any adult 170 to 180 cm tall, the average depth for a left-sided DLT is 29 cm. For every 10-cm increase or decrease in height, the DLT is advanced or withdrawn 1 cm.
3. Placement of Double-Lumen Tubes
   1. The insertion of the tube is performed with the distal concave curvature facing anteriorly. After the tip of the tube is past the vocal cords, the stylet is removed, and the tube is rotated through 90 degrees. A left-sided tube is rotated 90 degrees to the left, and a right-sided tube is rotated to the right. Advancement of the tube ceases when moderate resistance to further passage is encountered, indicating that the tube tip has been firmly seated in the main stem bronchus (Fig. 37-3: Left main stem endobronchial intubation using a Carlens tube).
   2. When the tube is believed to be in the proper position, a sequence of steps should be performed to check its location (Table 37-6: Steps to Verify The Position of a Double-Lumen Tube).
   3. Confirmation of placement using a fiberoptic bronchoscope is recommended (Table 37-7: Use of a Fiberoptic Bronchoscope to Verify Proper Placement of a Double-Lumen Tube; Fig 37-4: Fiberoptic bronchoscopic view of the main carina (A), “left bronchial carina” (B), and right bronchus (C) and Fig 37-5: Malposition of the left bronchial limb of the double-lumen tube (DLT)).
4. Lung separation in a patient with a tracheostomy may be achieved with a separately inserted bronchial blocker. (Standard DLTs are usually too stiff to negotiate the curve required for insertion through a tracheal stoma.)
5. Lung separation in a patient with a difficult airway may include use of a flexible fiberoptic endoscope, a DLT or Univent tube using a tube exchanger plus laryngoscopy, or a tube exchanger and bronchial blocker.

Anesthesia for Thoracic Surgery

1. Preoperative Evaluation
2. Preoperative Preparation
3. Intraoperative Monitoring
4. One-Lung Ventilation
5. Management of One-Lung Ventilation
6. Clinical Approach to Management of One-Lung Ventilation
7. Choice of Anesthesia for Thoracic Surgery
8. Hypoxic Pulmonary Vasoconstriction
9. Anesthesia for Diagnostic Procedures
10. Anesthesia for Special Situations
11. Myasthenia Gravis
12. Postoperative Management and Complications