Thoracic Surgery, One-Lung Ventilation (OLV), and Pulmonary Resections — WACS Viva & Clinical Scenarios (Cardiothoracic)

Exam-style thoracic surgery, one-lung ventilation (olv), and pulmonary resections viva scenarios with examiner probes and model answers for ANAESTHESIA…

Scenarios covered

• SCENARIO 1: A 52-year-old male (ASA III) with chronic post-TB left destroyed lung is booked for open left pneumonectomy. You do not have a flexible fibreoptic bronchoscope available in theatre. How do you select, place, clinically verify, and secure a left-sided Double Lumen Tube (DLT)?
• SCENARIO 2: During One-Lung Ventilation for a right upper lobectomy in a 60-year-old smoker with COPD, the SpO2 progressively falls from 98% to 82% on an FiO2 of 0.8. Detail your systematic, stepwise algorithm to investigate and correct intraoperative hypoxaemia during OLV.
• SCENARIO 3: A 40-year-old male with a massive left-sided emphysematous bulla occupying 60% of the hemithorax presents for bullectomy. Outline your induction strategy, ventilation precautions, and specific hazards of positive pressure ventilation and nitrous oxide.
• SCENARIO 4: A 28-year-old female with Myasthenia Gravis (Osserman Class IIb, on pyridostigmine and prednisone) is scheduled for elective transsternal thymectomy. How do you evaluate her preoperative respiratory reserve, plan your anaesthetic induction and muscle relaxant strategy, and formulate extubation criteria?