ABSTRACT : Thoracic surgeries frequently requires one lung ventilation(OLV). For OLV in many cases, double-lumen endotracheal tubes are the first choice for airway management as these are easier to place, and less prone to malposition than bronchial blockers.

METHODS : A 40-year-old male,ASA physical status III, with a known history of MDR-tuberculosis was admitted for left lung upper lobectomy.Significant medical history included MDR-TB for which he is on category-IV ATT for 8 months,Type-2 DM,and ETOH + . On physical examination,the patient\'s height was 170cm,and he weighed 58kg.Vitals were good.Airwayexamination revealed Mallampati grade 2.Preoperative chest radiograph showed cavity in left upper lobe with meniscus sign.PFT\'s showed restrictive lung disease pattern.Sputum examination and culture for AFB and Aspergillus was negative.ECG and echocardiogram revealed no cardiac abnormality.HRCT chest revealed findings suggestive of Bilateral koch\'s with left upper lobe fungal ball of size 4.6×6 cm.The results of all preoperative laboratory tests were within normal limits.

RESULTS : The patient was scheduled for left upper lobectomy.General anesthesia was achieved with a left sided double-lumen endotracheal tube(Mallinckrodt PVC double lumen tubed).After checking proper tube placement, patient was kept in left lateral position.OLV was established and surgery completed uneventfully.

CONCLUSIONS : This report documents OLV of 3 hour duration using a double-lumen endotracheal tube without supplemental CPAP and PEEP to maintain an oxyhemoglobin of more than 97 % measured by pulse oximetry.This case describes appropriate preoperative patient selection and intraoperative airway management plans for the proper use of one lung anesthesia airway devices.