Second thoracoscopic left lobectomy in a case of difficult single lung ventilation during left tracheobronchial intubation

Abstract

Abstract Background The accessory bronchus is a physiological congenital malformation suggestive of abnormal bronchial growth that is present in 0.1%-2% of the general population. Providing adequate perioperative single-lung ventilation and airway management to affected patients remains a persistent challenge facing anesthesiologists. Case presentation In the present report, we describe a rare case of abnormal airway anatomy in a patient with lung cancer who exhibited a bronchial opening entering the right upper lobe and who had a history of right lower lobectomy for lung cancer. In addition to the normal opening, this patient exhibited a distinct tracheobronchial opening in the upper right lobe of the lung originating directly from the trachea and above the protuberans. However, the patient had two side tracheal bronchi that he could see above the bronchus. Using left single lumen endotracheal intubation and right lung single lung ventilation, the patient underwent left lower lung lobectomy, and no anesthetic complications were observed during recovery. Conclusions In this case, timely tracheobronchial identification and successful single-lung ventilation of the right lung while avoiding hypoxemia were central to appropriate anesthesia management.