Onimaru Taichi, Kamata Mineto, Nakagawa Hideyuki
Department of Anesthesiology, Saitama Medical University International Medical Center, Saitama, Japan.
Department of Anesthesia, Teikyo University School of Medicine, Tokyo, Japan.
JA Clin Rep. 2022 Jul 25;8(1):55. doi: 10.1186/s40981-022-00545-0.
Establishing one-lung ventilation (OLV) in patients with tracheal bronchus (TB) may be challenging due to its unusual bronchial anatomy. We present a case of difficult OLV in a patient with right TB and steeply angled bifurcation of the left main bronchus.
A 79-year-old woman was scheduled to undergo video-assisted thoracic surgery left upper lobectomy. We planned right OLV with a bronchial blocker; however, it was difficult to place the blocker in the left main bronchus due to a steep bifurcation angle. Therefore, we changed the entry angle of the lumen tip by advancing the tracheal tube to just above the tracheal bifurcation, allowing successful placement of the bronchial blocker into the bronchus.
For airway management in patients with TB, especially for OLV, it is essential to understand the anatomy of the trachea, bronchus, and TB and to select the appropriate device for each case.
由于气管支气管（TB）患者的支气管解剖结构异常，建立单肺通气（OLV）可能具有挑战性。我们报告一例右TB且左主支气管分叉角度陡峭的患者进行OLV困难的病例。
一名79岁女性计划接受电视辅助胸腔镜手术左上叶切除术。我们计划使用支气管封堵器进行右侧OLV；然而，由于分叉角度陡峭，难以将封堵器放置在左主支气管内。因此，我们将气管导管推进到气管分叉上方，改变管腔尖端的进入角度，从而成功地将支气管封堵器放置到支气管内。
对于TB患者的气道管理，尤其是OLV，了解气管、支气管和TB的解剖结构并为每个病例选择合适的设备至关重要。
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