Progress in lung separation.

The progress in lung separation technology has allowed anesthesiologists to become skillful in fiberoptic bronchoscopy techniques and to provide excellent lung exposure in thoracic surgery patients. Given the availability of two technologies--DLTs (right-sided and left-sided) and bronchial blocker technology (TCBU, Arndt, and Cohen--every case that requires lung collapse and OLV should receive the benefit of these devices. Because of its greater margin of safety, a left-sided DLT is the more common device used in lung separation. If any contraindication to placing a left-sided DLT exists, a right-sided DLT is an option for any specific situation (eg, left lung transplantation). For a patient who requires lung separation and presents with the dilemma of a difficult or abnormal airway, bronchial blockers offer more advantages. Regardless of the device used, the optimal position of these devices (DLTs and bronchial blockers) is achieved best with the use of fiberoptic bronchoscopy techniques first in supine and then in lateral decubitus position or whenever repositioning of the device is needed.