ABSTRACT
A sandbag is placed on the operating table prior to putting the patient on the table. The patient is induced with general anesthesia after placement of a thoracic epidural catheter. A Foley catheter and pneumatic compression stockings are placed. The endotracheal tube is positioned, and bronchoscopy is performed evaluating the trachea, right and left bronchi down to the subsegmental level. We then change the endotracheal tube to a double-lumen tube, and the patient is placed in the full lateral decubitus position. The patient’s superior posterior iliac spine is positioned at the level of the break in the table. The free arm is brought up, flexed at the elbow, and supported with a padded armrest. The bottom leg is flexed at the knee, and pillows are placed between the legs. Frequently, the bottom foot will need additional padding. The bed is maximally flexed to stretch the intercostal space. The axilla is usually adequately protected by the beanbag, although in some cases additional protection is required. The chest is prepped and draped.
