AANA Journal Course: update for nurse anesthetists--anesthesia for thoracic surgery: lung separation.

The lungs can be separated by use of either a double-lumen tube (DLT) or a bronchial blocker (BB). Correct positioning of DLTs and BBs is often the most important determinant as to whether thoracic surgery cases (in particular one-lung ventilation cases) and differential lung ventilation in the intensive care unit proceed smoothly. If the method of lung separation is correct, the operative nondependent lung will collapse completely and easily, the surgeon will be able to work efficiently without damaging the operative lung, and the nonoperative lung will be unobstructed and easy to ventilate. For both DLTs and BBs, the key to precise positioning is to visualize, with a fiberoptic bronchoscope, through the tracheal lumen, the occluding endobronchial cuff/balloon just below the tracheal carina.