Flow-controlled One-lung Ventilation During Carinal Sleeve Reconstruction: Anaesthetic Management and Technical Feasibility

Carinal sleeve resection with reconstruction represents one of the most challenging thoracic surgical procedures and requires meticulous anaesthetic management to maintain adequate gas exchange within a shared and surgically interrupted airway while preserving an unobstructed surgical field. Conventional ventilation strategies, including cross-field ventilation and high-frequency jet ventilation, may interfere with surgical exposure or result in unstable ventilation. We describe the anaesthetic management of a 64-year-old male patient in whom flow-controlled ventilation- one-lung ventilation (FCV-OLV) was employed during carinal sleeve lobectomy with reconstruction. Following initial double-lumen tube ventilation, FCV was established using a Tritube® connected to an Evone® ventilator and maintained throughout airway reconstruction. Ventilation was achieved without interruptions, apneic periods, or cross-field ventilation. Oxygenation and carbon dioxide elimination remained stable during 180 minutes of FCV, while the small-lumen tube provided optimal surgical exposure. The patient was extubated uneventfully at the end of surgery and experienced an uncomplicated postoperative course. This case highlights the feasibility of flow-controlled OLV as an anaesthetic strategy during complex airway reconstruction. FCV-OLV enabled uninterrupted ventilation, stable gas exchange, and excellent surgical conditions without the need for extracorporeal support or alternative ventilation techniques.