[Isolated rupture of the left main-stem bronchus during intubation with a Carlens tube]

[Rupture of the left bronchus during intubation by Carlens tube]

The authors report a case of left main bronchus rupture following endotracheal intubation with a Carlens double-lumen tube. The bronchus rupture occurred during a cure of gastro-oesophageal-reflux and resection of oesophageal diverticula through a left thoracotomy. The patient was a 65-year-old woman treated with corticosteroids for an Addison's disease. The weakness of the bronchial wall initiated by the steroid hormones was an important factor contributing to the perforation. There is also a higher risk of rupture during oesophageal surgery because of surgical dissection and stretch on the tracheobronchial airway. This case demonstrates that such a complication can occur without ventilatory failure. A rupture must be recognized and treated surgically very rapidly. Recommendations regarding the use of double-lumen endotracheal tubes are reviewed in order to decrease the occurrence of such a complication.

[Peroperative pneumothorax in thoracotomy: the value of pulse oximetry]

Two cases of pneumothorax occurring during thoracotomy under one-lung ventilation are reported. One case occurred before pneumonectomy was carried out. The decrease in Spo2 shown by pulse oximetry, together with the increase in airway pressures, rapidly led to the diagnosis of pneumothorax. In the other case, the accident occurred after pneumonectomy, with a suddenly impossible ventilation, and a drastic decrease in Spo2 leading to hypoxic circulatory arrest. Hypoxaemia occurring during one-lung ventilation may be due to different causes. Shunting in the upper part of the lung is the main cause, but other diagnoses must be discussed, such as airway obstruction by blood or sputum, displacement of the selective endotracheal tube, bronchospasm, and pneumothorax. Monitoring of Spo2 by pulse oximetry would therefore seem to be mandatory during thoracic surgery, in order to allow an early diagnosis of hypoxaemia and speed up the treatment of its cause.