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

• 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
• ISSN: 0952-8180; 1873-4529
• DOI: 10.1016/j.jclinane.2013.01.018

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.