Anesth Analg 2004;98:270
© 2004 International Anesthesia Research Society
LETTERS TO THE EDITOR
Successful Lung Isolation with One Bronchial Blocker in a Patient with Tracheal Bronchus
Nobuhide Kin,
Kaori Tarui, and
Kazuo Hanaoka
Department of Anesthesiology, University of Tokyo Hospital, Tokyo, Japan
To the Editor:
Tracheal bronchus, whose incidence is approximately 2%, is not a rare anomaly (1). It almost always occurs in the right upper lobe bronchus and can develop anywhere above the carina in the right lateral wall of trachea but usually within a 2-cm range (2). To isolate the right lung with tracheal bronchus, either an endobronchial tube or two bronchial blockers may be needed (3,4). We successfully isolated the right lung by deliberately herniating the balloon of one bronchial blocker. For thoracoscopic resection of right chest wall tumor of a 62-yr-old female patient, we used a regular endotracheal tube of 8.5-mm internal diameter with a bronchial blocker (Endobronchial Blocker Tube, Coopdech, Osaka, Japan) after failure of inserting a left side endobronchial tube. Thereafter, the thoracoscope showed the right upper lobe was still being ventilated even though the middle and lower lobes were not. Reinspection with FOB revealed that there is a small gap between the balloon and the trachea (Fig. 1), which was not detected before and was part of the right upper lobe tracheal bronchus opening. To seal the exit of tracheal bronchus with the balloon, the blocker was withdrawn about 5 mm. That resulted in a partially herniated balloon into the left main bronchus (Fig. 2), but since airway pressure did not increase and the right upper lobe stopped being ventilated, we proceeded with the blocker position being continuously monitored with FOB. The surgery completed without any further obstruction of the thoracoscopic view or any difficulty in ventilation (Fig. 3). With FIO2 of 1.0, the pulse oximeter showed 100 % throughout the case, which lasted 50 min. Although an endobronchial tube should be used for lung isolation in tracheal bronchus patients, using one bronchial blocker is possible if the distance between the carina and the tracheal bronchus is short enough.
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Figure 1. Fiberscopic view from the trachea. A gap is seen above the balloon (arrow). LMB = left main bronchus.
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References
- O’Sullivan BP, Frassica JJ, Rayder SM. Tracheal bronchus: a cause of prolonged atelectasis in intubated children. Chest 1998; 113: 537–40.[Abstract/Free Full Text]
- Setty SP, Michaels AJ. Tracheal bronchus: case presentation, literature review, and discussion. J Trauma 2000; 49: 943–5.[Medline]
- Lee HL, Ho AC, Cheng RK, Shyr MH. Successful one-lung ventilation in a patient with aberrant tracheal bronchus. Anesth Analg 2002; 95: 492–3.[Abstract/Free Full Text]
- Peragallo RA, Swenson JD. Congenital tracheal bronchus: the inability to isolate the right lung with a Univent bronchial blocker tube. Anesth Analg 2000; 91: 300–1.[Abstract/Free Full Text]
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