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To the Editor:—
This is a preventable complication of endotracheal anesthesia. The cause and prevention are simple. The right upper lobe atelectasis results when the endotracheal tube is inserted too deeply into the tracheobronchial tree and the lip of the endotracheal tube rests against the right upper lobe orifice, obstructing it and causing atelectasis of the right upper lobe.Prevention of this complication takes only a minute of the anesthetist's time. Before the endotracheal tube is inserted, it should be measured on the outside of the patient's neck so that it reaches almost but not quite to the angle of Louis. The angle of Louis corresponds to the bifurcation of the trachea and the carina internally. The endotracheal tube should be taped firmly to the patient's mouth so that it cannot slip deeper during operative manipulations.
Skinner EF. Atelectasis After Endotracheal Anesthesia. JAMA. 1967;199(3):223. doi:10.1001/jama.1967.03120030127040