Case Report (High Frequency/Small Tidal Volume Differential Lung Ventilation): A Technique of Ventilating the Nondependent Lung of One Lung Ventilation for Robotically Assisted Thoracic Surgery Bassam M. Shoman, Hany O. Ragab, Ammar Mustafa, and Rashid Mazhar Cardiothoracic Anesthesia Department, Heart Hospital, Hamad Medical Corporation, P.O. Box 3050, Doha, Qatar Correspondence should be addressed to Bassam M. Shoman; baskalito@hotmail.com Received 20 March 2015; Revised 29 July 2015; Accepted 30 July 2015 Academic Editor: Maria Jose C. Carmona Copyright © 2015 Bassam M. Shoman et al. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. With the introduction of new techniques and advances in the thoracic surgery felds, challenges to the anesthesia techniques had became increasingly exponential. One of the great improvements that took place in the thoracic surgical feld was the use of the robotically assisted thoracic surgical procedure and minimally invasive endoscopic thoracic surgery. One lung ventilation technique represents the core anesthetic management for the success of those surgical procedures. Even with the use of efective one lung ventilation, the patient hemodynamics and respiratory parameters could be deranged and could not be tolerating the procedure that could compromise the end result of surgery. We are presenting our experience in managing one patient who sufered persistent hypoxia and hemodynamic instability with one lung ventilation for robotically assisted thymectomy procedure and how it was managed till the completion of the surgery successfully. 1. Introduction Te development of lung isolation and one lung ventilation (OLV) accelerated the evolution of thoracic surgery as a sub- specialty. Before the introduction of endotracheal tube and the cufed endotracheal tube, only select few intrathoracic procedures were feasible. Rapid lung movement and quickly developing respiratory distress made the surgical procedures difcult and risky. Selective ventilation of one lung changed this scenario. It was frst described in 1931 by Gale and Water and quickly led to increasingly complex lung resection surgery, with the frst published pneumonectomy for cancer in 1933 [1]. Techniques and apparatus used for OLV have changed signifcantly in recent years. Tese changes have come largely in response to an increased use of OLV during lung surgery and the advent of newer, minimally invasive surgical procedures, whereas OLV in the operating room or intensive care unit was once viewed as a complex endeavor largely managed by experts in academic institutions. Te introduction of newer limited access thoracic and cardiac procedures has made it necessary as anesthesia staf members to master lung isolation techniques. Modifcation of OLV technique is sometimes needed during the procedure to face the potential problems that could change the plans and covert the procedure to conventional lung ventilation. Te well- known methods of increasing FIO 2 , applying PEEP to the ventilated lung, use of CPAP to the nonventilated lung, or intermittent reinfation of the collapsed lung may not work to improve hypoxia and hypercarbia associated with OLV. In this case report we are presenting a modifcation of the diferential lung ventilation technique for managing hypoxia and hypercarbia during robotic assisted thymectomy using OLV [2]. 2. Case Report A 35-year-old female Asian patient who is known to be nonsmoker and nonalcoholic referred by the infection con- trol department to the cardiothoracic surgery team afer Hindawi Publishing Corporation Case Reports in Anesthesiology Volume 2015, Article ID 631450, 3 pages http://dx.doi.org/10.1155/2015/631450