Microlaryngeal Tube-assisted Airway Rescue Following Intraoperative Haemorrhage during Right Bilobectomy for Bronchial Carcinoid - A Case Report

A 29-year-old female (165 cm, 68 kg) with a 4.9 cm × 3.2 cm × 3.5 cm carcinoid tumour in the right intermediate bronchus underwent right bilobectomy. Despite pre-operative computed tomography showing anatomical distortion warranting fibre-optic guidance, blind placement of a 35-Fr left-sided double-lumen tube was attempted. We inadvertently placed the tube into the right bronchus, traumatising the tumour and causing significant haemorrhage. After a failed 9-Fr Cohen bronchial blocker placement, successful lung isolation was achieved using a 5.0-mm microlaryngeal surgery tube placed under fibreoptic guidance. This represents the first reported adult use of a microlaryngeal tube for emergency lung isolation following double-lumen tube-induced haemorrhage. One-lung ventilation was maintained for 4.5 h without complications. The case demonstrates that pre-operative anatomical distortion mandates fibreoptic-guided double-lumen tube placement and highlights the microlaryngeal tube as a viable rescue option when conventional devices fail. Thoracic anaesthesiologists should maintain proficiency with multiple lung isolation techniques and have immediate access to alternative devices.