The use of bronchial blockers in patients with aberrant tracheobronchial anatomy: a case report

Abnormal tracheal bronchus originates from the sidewall of the trachea, and most frequently occurs on the right side, involves subsegmental bronchi and the segmental. The anatomical structure of the airway is of great significance for general anesthesia and lung isolation. Abnormal tracheal bronchus makes lung isolation more complicated. This study presents four rare cases of aberrant tracheobronchial anatomy in the right main bronchus. We review the literature and discuss our solution and propose possible solutions for lung isolation in patients with tracheobronchial abnormalities. Of these, three patients were scheduled for radical resection of lung cancer, and one patient was scheduled for radical resection of middle esophageal cancer. After anesthesia induction, we intubated the right-side double-lumen tube (DLT) using a fiberoptic bronchoscope to guide the intubation. During DLT repositioning, we discovered the tracheobronchial abnormality of the patients. We could not place the DLT appropriately, however we made an effort to achieve lung isolation. We used a bronchus blocker [(BB) Univent tube] to achieve lung isolation for case 1, and the patient had good ventilation and no dyspnea and carbon dioxide retention during the operation. We completed lung isolation for the other three patients with abnormal airways by adjusting the position and replacing the DLT.