Difficulty in placement of a left-sided double-lumen tube due to aberrant tracheobronchial anatomy

Abstract A rare case of a tracheal bronchus coexisting with a left-shifted carina and an acute angle of left main bronchus is presented. A 66 year old man with a history of colon cancer was scheduled for right thoracoscopic pericardial window due to recurrent pericardial effusion. After induction of...

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Bibliographic Details
Published in:Journal of clinical anesthesia 2013-08, Vol.25 (5), p.413-416
Main Authors: Yoshimura, Tatsuya, MD, Ueda, Ken-ichi, MD, Kakinuma, Akihito, MD, Nakata, Yoshinori, MD, MBA
Format: Article
Language:English
Subjects:
Aberrant tracheal anatomy
Aged
Airway management
Anesthesia
Anesthesia & Perioperative Care
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Biological and medical sciences
Bronchi - abnormalities
Bronchoscopy - methods
Catheters
Double-lumen endotracheal tube
Fiber Optic Technology
Humans
Intubation, Intratracheal - methods
Lung isolation
Lungs
Male
Medical sciences
One-lung ventilation
One-Lung Ventilation - methods
Pain Medicine
Pediatrics
Pericardial Effusion - surgery
Pericardial Window Techniques
Pneumology
Respiratory system : syndromes and miscellaneous diseases
Thoracoscopy - methods
Tidal Volume
Trachea - abnormalities
Tracheal bronchus
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Summary:Abstract A rare case of a tracheal bronchus coexisting with a left-shifted carina and an acute angle of left main bronchus is presented. A 66 year old man with a history of colon cancer was scheduled for right thoracoscopic pericardial window due to recurrent pericardial effusion. After induction of anesthesia, the trachea was intubated using a 39-French, left-sided double lumen tube (DLT); the DLT was positioned with fiberoptic bronchoscopic guidance. Significantly high airway pressure was noticed as we initiated one-lung ventilation after the patient was positioned in the left lateral decubitus position. While repositioning the DLT, we found an aberrant tracheal bronchus. Although multiple attempts were made to adjust the DLT so as to achieve lung isolation, we could not place the DLT in the appropriate position due to abnormal and distorted anatomy. Lung isolation was unsuccessful; both lungs were carefully ventilated with small tidal volumes.
ISSN:0952-8180
1873-4529
DOI:10.1016/j.jclinane.2013.01.018