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*Department of Anaesthesia & Intensive Care,
Diagnostic Radiology and Organ Imaging,
Department of Surgery, The Chinese University of Hong Kong and Prince of Wales Hospital, Shatin, NT, Hong Kong SAR, PRC, and
Brock University, St. Catharines, Ontario, Canada.
Address correspondence and reprint requests to Anthony Ho, MSc, MD, FRCPC, FCCP, Professor, Department of Anesthesia & Intensive Care, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR. Address email to hoamh{at}cuhk.edu.hk
During double-lumen tube (DLT) placement, the anesthesiologist must be mindful of the margin of safety. We determined how this margin is affected by the presence of a tracheal bronchus by elucidating the mathematical relationship between some relevant physical dimensions of the trachea, bronchi, and DLT. Our results suggest that a tracheal bronchus only rarely affects the intrinsic margin of safety of DLT placement. When the tracheal bronchus is located much higher than its most frequently seen location (within 2 cm from the carina), however, there is increased risk that it could be blocked by the tracheal cuff of a left-sided DLT.
IMPLICATIONS: An orifice arising on the right tracheal wall to supply all or part of the right upper lobe occurs with a frequency of 
0.5%. Because tracheal bronchi usually arise at within 2 cm of the carina, they should only rarely reduce the intrinsic margin of safety of left-sided double-lumen tubes.
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