Airway management for a patient with tracheobronchomegaly undergoing lobectomy: a case report

• Published in: BMC anesthesiology Vol. 23; no. 1; pp. 1 - 357
• Main Authors: Wang, Sai-Nan, Wu, An-Shi, Miao, Jin-Bai, Chen, Shuo, Jiang, Jia
• Format: Journal Article
• Language: English
• Published: London BioMed Central Ltd 02.11.2023; BioMed Central; BMC
• Subjects: Airway management; Anesthesia; Balloon treatment; Blood pressure; Bronchoscopy; Bronchus; Case Report; Catheters; Computed tomography; Double-lumen Foley catheter; Equipment and supplies; Fiber optics; Intubation; Laryngeal mask airway; Lungs; Medical personnel; One-lung ventilation; Patients; Pneumothorax; Respiratory tract; Sufentanil; Surgeons; Surgery; Thoracic surgery; Thorax; Throat; Tracheobronchomegaly; Ventilation
• ISSN: 1471-2253; 1471-2253
• DOI: 10.1186/s12871-023-02324-5

Abstract Background Tracheobronchomegaly (TBM) is a rare disorder mainly characterized by dilatation and malacia of the trachea and major bronchi with diverticularization. This will be a great challenge for airway management, especially in thoracic surgery requiring one-lung ventilation. Using a laryngeal mask airway and a modified double-lumen Foley catheter (DFC) as a “blocker” may achieve one-lung ventilation. This is the first report introducing this method in a patient with TBM. Case presentation We present a 64-year-old man with TBM receiving left lower lobectomy. Preoperative chest computed tomography demonstrated a prominent tracheobronchial dilation and deformation with multiple diverticularization. The most commonly used double-lumen tube or bronchial blocker could not match the distorted airways. After general anesthesia induction, a 4# laryngeal mask was inserted, through which the modified DFC was positioned in the left main bronchus with the guidance of a fiberoptic bronchoscope. The DFC balloon was inflated with 10 ml air and lung isolation was achieved without any significant air leak during one-lung or two-lung ventilation. However, the collapse of the non-dependent lung was delayed and finally achieved by low-pressure artificial pneumothorax. The surgery was successful and the patient was extubated soon after the surgery. Conclusions Using a laryngeal mask airway with a modified double-lumen Foley catheter acted as a bronchial blocker could be an alternative method to achieve lung isolation.