Microlaryngeal endotracheal tube for lung isolation in pediatric patient with significant tracheal narrowing

A 15-year-old boy, weighing 45 kg, 160 cm height with large anterior mediastinal mass and significant tracheal narrowing was scheduled for thoracotomy and excision of the mass. He had a history of progressive dyspnea, inability to lie supine, and a right upper hemithorax mass 13 cm × 13 cm × 11 cm as evident on a computerized tomography with significant compression of the trachea and right main stem bronchus. Inhalational induction was carried out using sevoflurane with 100% oxygen. After achieving adequate depth of anesthesia with the maintenance of spontaneous respiration with oxygen and sevoflurane (minimum alveolar concentration 1.7), left principal bronchus was intubated under fiber-optic bronchoscopy, with 5 mm cuffed microlaryngeal surgery tube. Excellent lung isolation was achieved. Selection of endotracheal tube for lung isolation and endobronchial intubation in the presence of significant tracheal narrowing are discussed.