Tracheal Bronchus: Anesthetic Implications and Importance of Early Recognition in the Context of Bronchial Blocker Use for Lung Isolation
- Resource Type
- Authors
- Michael Fabbro; Edward Maratea; Dao M. Nguyen; Lilibeth Fermin; Pankaj Jain
- Source
- Journal of cardiothoracic and vascular anesthesia. 34(4)
- Subject
- medicine.medical_specialty
Isolation (health care)
medicine.medical_treatment
Context (language use)
Bronchi
030204 cardiovascular system & hematology
03 medical and health sciences
0302 clinical medicine
030202 anesthesiology
medicine
Intubation, Intratracheal
Humans
Anesthetics
Bronchus
Lung
business.industry
respiratory system
Bronchial blocker
Respiration, Artificial
respiratory tract diseases
One-Lung Ventilation
Anesthesiology and Pain Medicine
medicine.anatomical_structure
Tracheal bronchus
Anesthetic
Airway management
Radiology
Cardiology and Cardiovascular Medicine
business
medicine.drug
- Language
- ISSN
- 1532-8422
The right upper lobe (RUL) bronchus usually originates distal to the carina. A tracheal bronchus is a variant of this anatomy that (most often) describes a RUL originating from the trachea proximal to the carina. The preoperative (via chest computerized tomographic scan) or intraoperative (via fiberoptic bronchoscopy) recognition of a tracheal bronchus is important because its presence may complicate lung isolation strategies, especially when right lung isolation is planned with a bronchial blocker through a single-lumen endotracheal tube. We present three patients in whom unanticipated post-intubation discovery of this tracheobronchial variant led to a change in airway management and lung isolation strategy in two. We also review the anatomy and classification of the tracheal bronchus and detail the clinical implications of its presence in the context of lung isolation and bronchial blocker use.