This document reviews tracheal bronchi and strategies for one-lung ventilation in patients with this anomaly. It begins with background on tracheal bronchi, including that they are a congenital anomaly occurring in 0.1-3% of people. It then discusses three classifications of tracheal bronchi and strategies for one-lung ventilation using double lumen tubes, bronchial blockers, or a single lumen tube. Key approaches involve using the classification to select the best device and techniques like sequential lung isolation.

1. REVIEW
TRACHEAL
BRONCHUS
One-Lung Ventilation in patients
with
Young-Jin Moon
tment
rtment of Anesthesiology and Pain Med
Asan Medical Center

2. CONTENTS
CAS
E
I. CASE presentation
REVIE
W
II. Tracheal
Bronchus?
III. Classification
IV. OLV of tracheal bronchus
; using bronchial blocker and DLT
V. In single lumen tube

3. BRONCHUS
0.1 - 3 %
Congenital anomaly of central airway
Bronchus originating from
Trachea
Right upper lobe >> Left upper lobe /
Both
Childhood : Wheezing, Infection,
Bronchiectasis,
Associated anomalies
Adult : Asymtommatic, Rarely malignancies
have minimal clinical implication,
BUT When OLV is ne

5. Normal Anatomy

6. Classification
Simplified by I.D. Conacher
Type I
Type II
Type III

7. Classification
Simplified by I.D. Conacher

8. Type 2Icm above the carina
with the distal trachea narrowed

9. Type II
> 2 cm above the carina
with normal diameter of the distal
trachea

10. Type III
< 2 cm above the level of the
carina

11. One-Lung Ventilation
Strategy
Sarah H., A&A 2011 : Challenging Lung Isolation Secondary
to Aberrant Tracheobronchial Anatomy
Rt.
main
Lt. main
Tracheal
bronchus

12. One-Lung Ventilation
Strategy
Anthony M.-H. Ho, A&A 2004
:tracheal bronchus <2 cm of the carina
DLT is available
Type III
Lt.

13. One-Lung Ventilation
Strategy : Sequential One-Lung Isolation
William C. Culp, A&A 2004
Using a Double Arndt Bronchial
Blocker Technique

14. In Single lumen
Y.S. Choi, Y.L. Kwak,
tube? KJA 2010 :
Problematic tracheal intubation
with unrecognized
tracheal bronchus
Repeated sudden increased of PIP with a falling VT
Tracheal Bronchus was diagnosed
after operation

15. Reference
1.
Conacher, I. D. (2000). Implications of a tracheal bronchus for adult anaesthetic practice. British Journal of Anaesthesia, 85(2), 317–320.
2.
Brodsky, J. B., & Mark, J. B. (1991). Bilateral upper lobe obstruction from a single double-lumen tube. Anesthesiology, 74(6), 1163–1164.
3.
Campos, 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.0b013e3280111e2a
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 -A case report. Korean Journal of Anesthesiology, 59(Suppl), S13. doi:10.4097/kjae.2010.59.S.S13
5.
Culp, 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
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 Affect the Margin of Safety of Double-Lumen Tube Placement? Anesthesia & Analgesia, 99(1), 293–295.
doi:10.1213/01.ANE.0000118106.09944.E7
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 & Analgesia, 95(2), 492–493. doi:10.1213/01.ANE.0000021364.42109.AA
8.
Stene, R., Rose, M., Weinger, M. B., Benumof, J. L., & Harrell, J. (1994). Bronchial trifurcation at the carina complicating use of a doublelumen tracheal tube. Anesthesiology, 80(5), 1162–1164.
9.
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.2005.11.003
10. 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.0b013e318206917a
11. Yildiz, H., Ugurel, S., Soylu, K., Tasar, M., & Somuncu, I. (2006). Accessory cardiac bronchus and tracheal bronchus anomalies: CTbronchoscopy and CT-bronchography findings. Surgical and Radiologic Anatomy, 28(6), 646–649. doi:10.1007/s00276-006-0147-3