Figure 49-25 Lung separation with a single-lumen tube, fiberoptic bronchoscope, and right lung bronchial blocker. The sequence of events is as follows. A, A single-lumen tube is inserted and the patient is ventilated. B, A bronchial blocker is passed alongside the indwelling endotracheal tube. C, A fiberoptic bronchoscope is passed through a self-sealing diaphragm in the elbow connecter to the endotracheal tube and is used to place the bronchial blocker into the right main stem bronchus under direct vision. D, The balloon on the bronchial blocker is also inflated under direct vision and is positioned just below the tracheal carina. E, The fiberoptic bronchoscope is then removed. During the lower-panel sequence (insertion and use of the fiberoptic bronchoscope ([C to E]), the self-sealing diaphragm allows the patient to continue to be ventilated with positive-pressure ventilation (around the fiberoptic bronchoscope, but within the lumens of the endotracheal tube). LL, left lung; RL, right lung. (From Benumof JL: Anesthesia for Thoracic Surgery. Philadelphia, WB Saunders, 1987.)