Case report A 76-yr-old man was admitted for investigation of progressive hoarseness and shortness of breath on moderate exertion. Laryngoscopy, bronchoscopy and mediastinoscopy revealed a squamous cell carcinoma of the right vocal cord as well as a squamous cell carcinoma of the carina adjacent to the origin of the left main bronchus. There was a history of cigarette smoking and exposure to coal and gold dust, as well as mild hypertension treated with enalapril 5 mg od. He had undergone abdominal aortic aneurysm repair one year previously.Physical examination was unremarkable. Blood pressure was 130/60 mmHg. Haemoglobin, electrolyte and creatinine concentrations, liver function tests, chest x-ray and ECG were all within normal limits. His preoperative arterial blood gas analysis breathing room air showed: pH 7.44; PCO2 5.06 kPa (38 mmHg); PO2 I0.8 kPa (81 mmHg); HCO3 26 mmol-L -I, 02 sat 96%. Pulmonary function tests revealed a mild to moderate airflow limitation with hyperinflation and also moderate impairment of lung diffusion.It was decided to resect the carinal tumour first, and subsequently to irradiate the laryngeal lesion. The patient was scheduled for excision and reconstruction of the carina through a right posterolateral thoracotomy. Conduct of anaesthesiaThe patient received premedication with glycopyrrolate 0.2 mg ira. Following placement of a lumbar epidural catheter for postoperative analgesia, general anaesthesia was induced with propofol 100 mg and tracheal intubation was facilitated with succinylcholine 120 mg. A #14 F Fogarty occlusion catheter, used as a bronchial blocker, was inserted into the right main bronchus followed by intubation of the trachea with a 9.0 mm endotracheal tube. The position of both was confumed by fibreoptic bronchoscopy.Initally, anaesthesia was maintained with oxygen 40%, N20, halothane, fentanyl 100 Isg and muscle relaxation