Pediatric Lung isolation in a limited resource setup: a case report

Rationale: Pediatric lung isolation is a great challenge to anesthesiologists. Despite various advances in techniques and equipment in lung isolation, most of the sophisticated devices are unavailable in remote setups. Blind techniques have been used, but they have a low success rate. Patient concerns: Here we report a case of a five-year-old male child who had cough and fever for one month. CT scan of the chest revealed right-sided empyema thoracis for which decortication was planned under general anesthesia with one lung ventilation. Double lumen tube for this patient was not commercially available and we did not have a pediatric fiberoptic bronchoscope, which would fit inside the endotracheal tube necessary for the patient. Interventions: After anesthesia induction, an adult fiberoptic bronchoscope was used as an aid for insertion of bougie into the left mainstem bronchus followed by railroading the endotracheal tube over the bougie for lung isolation. Outcomes: Surgery then proceeded in the left lateral position with a right thoracotomy under a quiet surgical field. Conclusion: In the case of unavailability of pediatric fiberoptic bronchoscope, an adult fiberoptic bronchoscope and a bougie can aid in successful lung isolation in pediatric patients.