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REVIEWREVIEW
TRACHEAL BRONCHUSTRACHEAL BRONCHUSOne-Lung Ventilation in patients with One-Lung Ventilation in patients with
Young-Jin MoonYoung-Jin MoonDepartment of Anesthesiology and Pain MedicineDepartment of Anesthesiology and Pain Medicine
Asan Medical CenterAsan Medical Center
TABLE of CONTENTSTABLE of CONTENTS
I.I. CASE presentationCASE presentation
II. Tracheal Bronchus?II. Tracheal Bronchus?
III. ClassificationIII. Classification
IV. OLV of tracheal bronchusIV. OLV of tracheal bronchus ; using bronchial blocker and DLT ; using bronchial blocker and DLT
V. V. In siIn single lumen tubengle lumen tube
REVIEWREVIEW
CASECASE
Congenital anomaly of central airwayCongenital anomaly of central airway
0.1 - 3 %0.1 - 3 %
Right upper lobeRight upper lobe >>>> Left upper lobe / Both Left upper lobe / Both
Childhood : Wheezing, Infection, Bronchiectasis, Childhood : Wheezing, Infection, Bronchiectasis, Associated anomalies Associated anomalies
AdultAdult : : AsymtommaticAsymtommatic, Rarely malignancies, Rarely malignancies
have minimal clinical implication,have minimal clinical implication, BUT When OLV is needed... BUT When OLV is needed...
Bronchus originating from TracheaBronchus originating from Trachea
TRACHEAL BRONCHUSTRACHEAL BRONCHUS
Normal AnatomyNormal Anatomy
ClassificationClassification
Type IType I Type IIType II Type IIIType III
Simplified by I.D. Conacher Simplified by I.D. Conacher
ClassificationClassificationSimplified by I.D. Conacher Simplified by I.D. Conacher
Type I Type I 2 cm2 cm above the carina above the carina
with the with the distal trachea narroweddistal trachea narrowed
Type IIType II > 2 cm> 2 cm above the carina above the carina with with normalnormal diameter of the distal diameter of the distal tracheatrachea
Type IIIType III < 2 cm < 2 cm above the level of the carinaabove the level of the carina
One-Lung Ventilation StrategyOne-Lung Ventilation Strategy
Lt. mainLt. main
Rt. mainRt. mainTracheal bronchusTracheal bronchus
Sarah H., A&A 2011Sarah H., A&A 2011 : : Challenging Lung IsolationChallenging Lung Isolation Secondary to Secondary to AAberrant Tracheobronchial Anatomyberrant Tracheobronchial Anatomy
Anthony M.-H. Ho, A&A 2004Anthony M.-H. Ho, A&A 2004 : :tracheal bronchus <2 cmtracheal bronchus <2 cm of the carina of the carina Lt. DLTLt. DLT is available is available
One-Lung Ventilation StrategyOne-Lung Ventilation Strategy
Type IIIType III
William C. Culp, A&A 2004William C. Culp, A&A 2004 : Sequential One-Lung Isolation : Sequential One-Lung Isolation Using a Using a Double Arndt Bronchial BlockerDouble Arndt Bronchial Blocker Technique Technique
One-Lung Ventilation StrategyOne-Lung Ventilation Strategy
YY.S..S. Choi, Y Choi, Y.L..L. Kwak, Kwak, KJA 2010KJA 2010 : : Problematic tracheal intubationProblematic tracheal intubation withwith unrecognized tracheal bronchus unrecognized tracheal bronchus
Repeated sudden increased of PIP with a falling VRepeated sudden increased of PIP with a falling VTT
In In Single lumen tuSingle lumen tube?be?
Tracheal Bronchus was diagnosed after operationTracheal Bronchus was diagnosed after operation
ReferenceReference1.1. Conacher, I. D. (2000). Implications of a tracheal bronchus for adult anaesthetic practice. British Journal of Anaesthesia, 85(2), 317–320.Conacher, I. D. (2000). Implications of a tracheal bronchus for adult anaesthetic practice. British Journal of Anaesthesia, 85(2), 317–320.
2.2. Brodsky, J. B., & Mark, J. B. (1991). Bilateral upper lobe obstruction from a single double-lumen tube. Anesthesiology, 74(6), 1163–1164.Brodsky, J. B., & Mark, J. B. (1991). Bilateral upper lobe obstruction from a single double-lumen tube. Anesthesiology, 74(6), 1163–1164.
3.3. Campos, J. H. (2007). Which device should be considered the best for lung isolation: double-lumen endotracheal tube versus bronchial blockers. CurrCampos, J. H. (2007). Which device should be considered the best for lung isolation: double-lumen endotracheal tube versus bronchial blockers. Current opinion in anaesthesiology, 20(1), 27–31. doi:10.1097/ACO.0b013e3280111e2aent opinion in anaesthesiology, 20(1), 27–31. doi:10.1097/ACO.0b013e3280111e2a
4.4. Choi, Y. S., Kwak, Y. L., Choi, H. G., Oh, S. Y., & Lee, J. W. (2010). Anesthetic experience of an adult patient with an unrecognized tracheal bronchus -Choi, Y. S., Kwak, Y. L., Choi, H. G., Oh, S. Y., & Lee, J. W. (2010). Anesthetic experience of an adult patient with an unrecognized tracheal bronchus -A case report. Korean Journal of Anesthesiology, 59(Suppl), S13. doi:10.4097/kjae.2010.59.S.S13A case report. Korean Journal of Anesthesiology, 59(Suppl), S13. doi:10.4097/kjae.2010.59.S.S13
5.5. Culp, W. C., Jr., & Kinsky, M. P. (2004). Sequential One-Lung Isolation Using a Double Arndt Bronchial Blocker Technique. Anesthesia & Analgesia, 99Culp, W. C., Jr., & Kinsky, M. P. (2004). Sequential One-Lung Isolation Using a Double Arndt Bronchial Blocker Technique. Anesthesia & Analgesia, 99(3), 945–946. doi:10.1213/01.ANE.0000132697.22933.8C(3), 945–946. doi:10.1213/01.ANE.0000132697.22933.8C
6.6. Ho, A. M. H., Karmakar, M. K., Lam, W. W. M., Lam, F. O., Lee, T. W., Ng, S. K., & Chung, D. C. (2004). Does the Presence of a Tracheal Bronchus AffHo, A. M. H., Karmakar, M. K., Lam, W. W. M., Lam, F. O., Lee, T. W., Ng, S. K., & Chung, D. C. (2004). Does the Presence of a Tracheal Bronchus Affect the Margin of Safety of Double-Lumen Tube Placement? Anesthesia & Analgesia, 99(1), 293–295. doi:10.1213/01.ANE.0000118106.09944.E7ect the Margin of Safety of Double-Lumen Tube Placement? Anesthesia & Analgesia, 99(1), 293–295. doi:10.1213/01.ANE.0000118106.09944.E7
7.7. Lee, H.-L., Ho, A. C., Cheng, R. K., & Shyr, M.-H. (2002). Successful one-lung ventilation in a patient with aberrant tracheal bronchus. Anesthesia & AnLee, H.-L., Ho, A. C., Cheng, R. K., & Shyr, M.-H. (2002). Successful one-lung ventilation in a patient with aberrant tracheal bronchus. Anesthesia & Analgesia, 95(2), 492–493. doi:10.1213/01.ANE.0000021364.42109.AAalgesia, 95(2), 492–493. doi:10.1213/01.ANE.0000021364.42109.AA
8.8. Stene, R., Rose, M., Weinger, M. B., Benumof, J. L., & Harrell, J. (1994). Bronchial trifurcation at the carina complicating use of a double-lumen tracheStene, R., Rose, M., Weinger, M. B., Benumof, J. L., & Harrell, J. (1994). Bronchial trifurcation at the carina complicating use of a double-lumen tracheal tube. Anesthesiology, 80(5), 1162–1164.al tube. Anesthesiology, 80(5), 1162–1164.
9.9. Suzuki, M., Matsui, O., Takemura, A., Kobayashi, T., Yoneda, K., & Shibata, Y. (2006). Four cases of accessory cardiac bronchus incidentally detected Suzuki, M., Matsui, O., Takemura, A., Kobayashi, T., Yoneda, K., & Shibata, Y. (2006). Four cases of accessory cardiac bronchus incidentally detected on multi-detector CT. European Journal of Radiology Extra, 57(2), 47–50. doi:10.1016/j.ejrex.2005.11.003on multi-detector CT. European Journal of Radiology Extra, 57(2), 47–50. doi:10.1016/j.ejrex.2005.11.003
10.10. Wiser, S. H., & Hartigan, P. M. (2011). Challenging Lung Isolation Secondary to Aberrant Tracheobronchial Anatomy. Anesthesia & Analgesia, 112(3), Wiser, S. H., & Hartigan, P. M. (2011). Challenging Lung Isolation Secondary to Aberrant Tracheobronchial Anatomy. Anesthesia & Analgesia, 112(3), 688–692. doi:10.1213/ANE.0b013e318206917a688–692. doi:10.1213/ANE.0b013e318206917a
11.11. Yildiz, H., Ugurel, S., Soylu, K., Tasar, M., & Somuncu, I. (2006). Accessory cardiac bronchus and tracheal bronchus anomalies: CT-bronchoscopy and Yildiz, H., Ugurel, S., Soylu, K., Tasar, M., & Somuncu, I. (2006). Accessory cardiac bronchus and tracheal bronchus anomalies: CT-bronchoscopy and CT-bronchography findings. Surgical and Radiologic Anatomy, 28(6), 646–649. doi:10.1007/s00276-006-0147-3CT-bronchography findings. Surgical and Radiologic Anatomy, 28(6), 646–649. doi:10.1007/s00276-006-0147-3