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• W1986993208 abstract "Tracheal bronchus is an airway that emerges from the lateral tracheal wall and is present in 1% to 3% of the population.1Barat M. Konrad H.R. Tracheal bronchus.Am J Otolaryngol. 1987; 8: 118-122Abstract Full Text PDF PubMed Scopus (62) Google Scholar, 2Ikeno S. Mitsuhata H. Saito K. et al.Airway management for patients with a tracheal bronchus.Br J Anaesth. 1996; 76: 573-575Crossref PubMed Scopus (69) Google Scholar, 3Conacher I.D. Implications of a tracheal bronchus for adult anaesthetic practice.Br J Anaesth. 2000; 85: 317-320Crossref PubMed Scopus (56) Google Scholar Although the tracheal bronchus usually is found 2 cm above the carina,1Barat M. Konrad H.R. Tracheal bronchus.Am J Otolaryngol. 1987; 8: 118-122Abstract Full Text PDF PubMed Scopus (62) Google Scholar it sometimes is identified 6 cm above the carina.4Ghaye B. Szapiro D. Fanchamps J.M. et al.Congenital bronchial abnormalities revisited.Radiographics. 2001; 21: 105-119Crossref PubMed Scopus (238) Google Scholar Tracheal stenosis distal to the tracheal bronchus3Conacher I.D. Implications of a tracheal bronchus for adult anaesthetic practice.Br J Anaesth. 2000; 85: 317-320Crossref PubMed Scopus (56) Google Scholar, 5Beierlein W. Elliott M.J. Variations in the technique of slide tracheoplasty to repair complex forms of long-segment congenital tracheal stenoses.Ann Thorac Surg. 2006; 82: 1540-1542Abstract Full Text Full Text PDF PubMed Scopus (49) Google Scholar, 6Speggiorin S. Torre M. Roebuck D.J. et al.A new morphologic classification of congenital tracheobronchial stenosis.Ann Thorac Surg. 2012; 93: 958-961Abstract Full Text Full Text PDF PubMed Scopus (58) Google Scholar and a shorter distance from the vocal cord to the tracheal bronchus,6Speggiorin S. Torre M. Roebuck D.J. et al.A new morphologic classification of congenital tracheobronchial stenosis.Ann Thorac Surg. 2012; 93: 958-961Abstract Full Text Full Text PDF PubMed Scopus (58) Google Scholar which are observed in only 5% of patients with tracheobronchial anomaly,6Speggiorin S. Torre M. Roebuck D.J. et al.A new morphologic classification of congenital tracheobronchial stenosis.Ann Thorac Surg. 2012; 93: 958-961Abstract Full Text Full Text PDF PubMed Scopus (58) Google Scholar include critical problems for the intraoperative airway management, especially in lung isolation.7Iwamoto T. Takasugi Y. Hiramatsu K. et al.Three-dimensional CT image analysis of a tracheal bronchus in a patient undergoing cardiac surgery with one-lung ventilation.J Anesth. 2009; 23: 260-265Crossref PubMed Scopus (9) Google Scholar, 8Wiser S.H. Hartigan P.M. Challenging lung isolation secondary to aberrant tracheobronchial anatomy.Anesth Analg. 2011; 112: 688-692Crossref PubMed Scopus (19) Google Scholar A 33-year-old woman (164 cm, 85 kg) was scheduled for resection of a sequestrated right lung segment connected to a tracheal bronchus. Preoperative computed tomography showed that the right tracheal bronchus was located 50 mm above the carina with a blind end about 20 mm from the tracheal bifurcation and that the internal diameters of the trachea above and below the tracheal bronchus were 13 mm and 6 mm, respectively (Fig 1). Given these abnormalities, use of a double-lumen tracheal tube to facilitate right lung isolation was rejected. Bronchoscopy prior to trachea intubation under general anesthesia revealed that the carina had a flattened shape with the bifurcation angle higher than normal and that the distance from the vocal cord to the tracheal bronchus was 82 mm.9Kim J.T. Kim H.J. Ahn W. et al.Head rotation, flexion, and extension alter endotracheal tube position in adults and children.Can J Anaesth. 2009; 56: 751-756Crossref PubMed Scopus (71) Google Scholar The trachea was intubated with an 8.0-mm internal diameter cuffed single-lumen reinforced tracheal tube to help manipulate the fiberoptic bronchoscope for the observation of the tracheal bronchus and for the bronchial blocker placement. The distance from the tip of the tracheal tube to the proximal edge of the cuff was 70 mm. Then, fiberoptic bronchoscopy and the Airwayscope (AWS) (Pentax-AWS®; Hoya, Tokyo, Japan) were used simultaneously to confirm that the tip of the tracheal tube was located proximal to the tracheal bronchus and that the proximal edge of the cuff was placed beyond the vocal cord (Video clip 1). We eventually did not apply a bronchial blocker to isolate the right lung because we wanted to avoid inadvertent mucosal edema of the congenitally-deformed trachea. After the patient was moved to the left lateral position, the position of the tip of the tracheal tube and the proximal edge of the cuff were confirmed using flexible fiberscopes (Video clip 2). These confirmations were repeated throughout anesthesia, and repositioning the tracheal tube was not required. Surgery was completed uneventfully under anterolateral thoracotomy without lung isolation. The postoperative course also was uneventful. In the present patient, advancement of the tracheal tube beyond the tracheal bronchus was restricted due to the small diameter of the trachea peripheral to the tracheal bronchus. Likewise, the proximal edge of the tracheal tube cuff should be placed beyond the vocal cord in order to avoid its injury caused by the cuff. Direct observation of the glottis using a laryngoscope can provide information on the relationship between the vocal cord and the tracheal tube cuff. However, head and neck movements can displace the tracheal tube.9Kim J.T. Kim H.J. Ahn W. et al.Head rotation, flexion, and extension alter endotracheal tube position in adults and children.Can J Anaesth. 2009; 56: 751-756Crossref PubMed Scopus (71) Google Scholar, 10Yap S.J. Morris R.W. Pybus D.A. Alterations in endotracheal tube position during general anaesthesia.Anaesth Intensive Care. 1994; 22: 586-588PubMed Google Scholar, 11Hartrey R. Kestin I.G. Movement of oral and nasal tracheal tubes as a result of changes in head and neck position.Anaesthesia. 1995; 50: 682-687Crossref PubMed Scopus (87) Google Scholar Therefore, we used the AWS that usually is used to place the tracheal tube with the patient’s neck in neutral position. As the AWS should not be kept in the oral cavity throughout anesthesia because of its rigidity, a flexible fiberscope was used to observe the glottis after initial tracheal tube placement. In conclusion, proper placement of the tracheal tube in a patient with the tracheal bronchus that originated high in the trachea and with the tracheal stenosis distal to the tracheal bronchus was facilitated by simultaneous observation of the tracheal tube position through a fiberoptic bronchoscope and the AWS. eyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiI2NjY1N2VjYTRkZGZmYzVmODY2NWRlYzkyZDE2NWE4NyIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNjc5Mjk4NjM1fQ.eYsWHf_xVWnGvUeuVc0mX1EOksEkvchDeMxfV-BodT5MYzPo3qeL9VSqeC6DaTH7DIJHa3hTbigChE6hJr1z3A2qGM1vVZc-_gkttsEHkzLJIgP8hkQir40MReoaxQtTVb9ZPLPun_8Z_wPxkCbyj_QRlneFGlC4asx2b3g_FMOZEEiQMG2l_Rj4iU6GNXgLtbk-jwFqCgclgcCa_HikIC5S6i5SWOhNQzg9qDNM6WwDMSjS756UXF0wAB5S3gZeBH2mz-QDR6Ego5x32N7e7CA5momgQAJ81Y25PTTIAt5Nucy21ArMNNQW4T31RqyMVr_TGi-f4KIuS4mRdvpGGg Download .mp4 (16.3 MB) Help with .mp4 files Video clip 1. Confirmation that the tip of the tracheal tube was located proximal to the tracheal bronchus and that the proximal edge of the cuff was placed beyond the vocal cord. eyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiJhN2Q3M2U5NGQ1YjIwNWNkZDBmNDA2YmI5NjQ2MTZjMiIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNjc5Mjk4NjM1fQ.f1J5UU3kD91hIy9ja9q9n8nU0T0AXDKk3NjCuHEGAtMkZznnSHcDmMe1LYmzteFqwkZs5XkLaICmAjg2tWNGK-m5dhIDLtrKRi_MbH8BnXiYIbvf8YhRtitAFwXnJ4kMezL7QUw60uxn0bHh4bU7wLeBaksds0dVavHX_9hWuL9kAnuFHsOyB8GEZ3vlNWmuPYFgzQEsvo-p63kj3aI0K-GheCl50xNYzioZ2fggRMUfoMBuCWtAf_feamjmmgIA0gOUC-dkZNvKa_RFG6m_CBF4K_5u7wEfmKM8KrCT0R4TEmvux1FCyPjT-_2UafFtfA_6GxZ2k0v6iTCSfoPqzg Download .mp4 (19.68 MB) Help with .mp4 files Video clip 2. Flexible fiberscope confirms the position of the proximal edge of the cuff." @default.
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• W1986993208 date "2015-04-01" @default.
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• W1986993208 title "Combined Airwayscope and Fiberoptic Bronchoscopic Airway Management in a Patient With a Tracheal Bronchus" @default.
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• W1986993208 doi "https://doi.org/10.1053/j.jvca.2014.10.003" @default.
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