Right upper lobe tracheal bronchus: anesthetic challenge in one-lung ventilated patients -A report of three cases-
A 77-year-old woman, with the weight of 63 kg, height of 153 cm, and classified as the American Society of Anesthesiologists (ASA) physical classification status II with carcinoma of the esophagus was scheduled for a subtotal esophagectomy, through a right thoracotomy approach. She had undergone a plication of the diaphragm for diaphragmatic eventration caused by phrenic nerve palsy through the same approach, 8 years before in our institution. The record showed a leftsided, 35 F double lumen tube (DLT) was used and no specific event was recorded. We used a BB (Coopdech®, Daiken medical, Osaka, Japan) to perform the left-sided OLV. A 2.2 mm fiberoptic bronchoscope (LF-P, Olympus, Tokyo, Japan) was advanced into the 7.0 single-lumen endotracheal tube (SLT), and confirmed the right positioning of the BB in the right main bronchus. Then, the balloon inflated with adequate volume of air. Unfortunately, we did not perform an auscultation of the chest, because we assured successful OLV based on the bronchoscopic finding. At the beginning of a surgery, blocker failed to provide satisfactory right upper lobe (RUL) collapse. A careful bronchoscopic examination revealed the presence of a smaller opening superior-lateral to blocker cuff. We replaced the BB with a left-sided, 35 F DLT (Mallinckrodt™, Covidien, Irland). Subsequent bronchoscopy showed the presence of the anomalous TB, approximately 2 cm proximal to the carina. Thereafter, routine bronchoscopy was performed prior to OLV to identify anatomic variants in our center.