Anaesthesia Challenges in Trauma to Airway During Thoracotomy Surgeries

Thoracic re-operations present significant anaesthetic challenges, particularly when prior airway trauma and the need for lung isolation coexist. We describe the anaesthetic management of a patient undergoing re-do left thoracotomy planned for lobectomy with the possibility of pneumonectomy. The initial surgical attempt was abandoned after transection of the left main bronchus due to unavailability of appropriate equipment, following which the patient developed clinical features suggestive of bronchopleural communication. During the subsequent surgery, lung isolation with a left-sided double-lumen tube was attempted; however, airway contamination with blood and secretions in the lateral position led to inadequate ventilation. Prompt exchange to a single-lumen endotracheal tube restored effective ventilation, allowing the procedure to proceed as a pneumonectomy. The patient was successfully extubated at the end of surgery with stable postoperative respiratory status. This case highlights the importance of anticipation of airway difficulties, continuous vigilance, and flexibility in airway management strategies during complex thoracic re-operations.