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Tracheal Bronchus Detected During General Anesthesia: A Case Report
Toru YamamotoDDS, PhD,
Tatsuru TsurumakiDDS, PhD,
Hiroko KanemaruDDS, PhD, and
Kenji SeoDDS, PhD
Article Category: Case Report
Volume/Issue: Volume 70: Issue 4
Online Publication Date: Jan 15, 2024
DOI: 10.2344/anpr-70-02-09
Page Range: 173 – 177

A tracheal bronchus is a congenital abnormality of the tracheobronchial tree in which a displaced or accessory bronchus arises from the trachea superior to the normal bifurcation at the carina. The main clinical implication of a tracheal bronchus arises during endotracheal intubation. 1 An endotracheal tube (ETT) can obstruct or migrate into a tracheal bronchus, causing pulmonary atelectasis and/or hypoxia. 2 – 5 We herein report a case of a tracheal bronchus that was incidentally found after induction of general anesthesia and discuss the

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Figure 2.; Tracheal Bronchus A, Fiberoptic view of the anomalous bronchus in the present case. Note that the orifice of the tracheal bronchus is positioned immediately to the right of the right main bronchus. B, Drawing of the bronchial anatomy showing the right upper lobe tracheal bronchus. • indicates carina; ▲, tracheal bronchus orifice.
Toru Yamamoto,
Tatsuru Tsurumaki,
Hiroko Kanemaru, and
Kenji Seo
Figure 2.
Figure 2.

Tracheal Bronchus

A, Fiberoptic view of the anomalous bronchus in the present case. Note that the orifice of the tracheal bronchus is positioned immediately to the right of the right main bronchus. B, Drawing of the bronchial anatomy showing the right upper lobe tracheal bronchus. • indicates carina; ▲, tracheal bronchus orifice.

Figure 4.; Schematic Representing the 3 Types of Tracheal Bronchus Likely to be of Significance to Anesthesiologists Type I, displaced right upper lobe tracheal bronchus. Type II, supernumerary right upper lobe tracheal bronchus. Type III (this case), displaced right upper lobe tracheal bronchus as tracheal trifurcation.
Toru Yamamoto,
Tatsuru Tsurumaki,
Hiroko Kanemaru, and
Kenji Seo
Figure 4.
Figure 4.

Schematic Representing the 3 Types of Tracheal Bronchus Likely to be of Significance to Anesthesiologists

Type I, displaced right upper lobe tracheal bronchus. Type II, supernumerary right upper lobe tracheal bronchus. Type III (this case), displaced right upper lobe tracheal bronchus as tracheal trifurcation.

Figure 3.; Portable AP Chest Radiograph Taken in OR After Intubation Note that the right upper lobe begins directly from the trachea and that the tube tip is located above all 3 apertures (red outline). AP indicates anterior-posterior; OR, operating room.
Toru Yamamoto,
Tatsuru Tsurumaki,
Hiroko Kanemaru, and
Kenji Seo
Figure 3.
Figure 3.

Portable AP Chest Radiograph Taken in OR After Intubation

Note that the right upper lobe begins directly from the trachea and that the tube tip is located above all 3 apertures (red outline). AP indicates anterior-posterior; OR, operating room.

Figure 1.; Preoperative Anterior-Posterior Chest Radiograph
Toru Yamamoto,
Tatsuru Tsurumaki,
Hiroko Kanemaru, and
Kenji Seo
Figure 1.
Figure 1.

Preoperative Anterior-Posterior Chest Radiograph

Airway Complications in Intubated Versus Laryngeal Mask Airway–Managed Dentistry: A Meta-Analysis
Jordan PrinceDDS, MSc,
Cameron GoertzenDDS, MSc,
Maryam ZanjirDDS,
Michelle WongDDS, MSc, EdD, and
Amir AzarpazhoohDDS, MSc, PhD
Article Category: Research Article
Volume/Issue: Volume 68: Issue 4
Online Publication Date: Dec 15, 2021
DOI: 10.2344/anpr-68-04-02
Page Range: 193 – 205

cancellation because of an airway concern, or an intraoperative change from the planned airway management technique. Secondary outcome measures were perioperative airway complications or potential complications, including hypoxia (defined as a reduced arterial oxygen saturation recorded after airway device removal and prior to discharge home, as well as the oxygen saturation criteria of each individual article); bronchospasm (defined as respiratory wheezing recorded prior to discharge home); airway obstruction (such as complete/partial obstructions or laryngospasms recorded

A Case of General Anesthesia for a Young Infant in Whom Intubation Was Suspected to Be Difficult Because of a Thyrolingual Cyst
Tomoyasu Noguchi,
Noriko Miyazawa,
Nami Ooyama, and
Tatsuya Ichinohe
Article Category: Research Article
Volume/Issue: Volume 65: Issue 2
Online Publication Date: Jan 01, 2018
DOI: 10.2344/anpr-65-02-04
Page Range: 127 – 128

prolonged apnea during the intubation process, an inner diameter of 3.5-mm uncuffed endotracheal tube was inserted through the right nasal cavity into the oropharynx and connected to the anesthetic circuit. After confirming the tracheal branch, the tracheal tube in the left nasal cavity was advanced to complete the tracheal intubation. Oxygen saturation was kept within the normal range during the process. Using this method, nasal intubation was successfully performed without hypoxia or hypercapnia in this 3-month-old infant. Figure 1

Cardiac Arrest Upon Induction of General Anesthesia
Regina A. E. DowdyDDS,
Shadee. T. MansourDDS,
James H. CottleDDS,
Hannah R. MabeDDS,
Harry B. WeprinDMD,
Leigh E. YarboroughDMD,
Gregory M. NessDDS,
Todd M. JacobsDMD, and
Bryant W. CorneliusDDS, MBA, MPH
Article Category: Case Report
Volume/Issue: Volume 68: Issue 1
Online Publication Date: Apr 07, 2021
DOI: 10.2344/anpr-67-03-08
Page Range: 38 – 44

Cardiac arrest in the perioperative period can be caused by many mechanisms, including hypoxia, hypovolemia, drug interactions, and vagal response to surgical stimulation medications or procedures. Essential steps in managing arrest include initiation of adequate cardiopulmonary resuscitation (CPR), administration of epinephrine, and use of defibrillator when applicable if return of spontaneous circulation is to occur. Utilization of standard monitoring equipment supported by proper knowledge of monitor interpretation will alert the

Unexpected Anesthetic Circuit Leak Attributed to Improper Use of a Tube Holder: A Case Report
Naotaka KishimotoDDS, PhD,
Akiko OtsukaDDS, PhD,
Tatsuru TsurumakiDDS, PhD, and
Kenji SeoDDS, PhD
Article Category: Case Report
Volume/Issue: Volume 68: Issue 3
Online Publication Date: Oct 04, 2021
DOI: 10.2344/anpr-68-02-02
Page Range: 154 – 157

Leaks in the anesthesia circuit can be caused by disconnection of or damage to the circuit tubing and can cause patient harm by inducing hypoxia, hypoventilation, and inadequate delivery of inhaled anesthetic agents and gases. Additionally, anesthetic circuit leaks can also lead to contamination of the operating room environment due to the escaping volatile anesthetics. 1 , 2 One potential cause of circuit disconnection is excessive strain placed on the endotracheal tube and its connection with the circuit resulting from the weight of the

Severe Intraoperative Bronchospasm Treated with a Vibrating-Mesh Nebulizer
Leonard R. GoldenMD,
Helen Ann DeSimoneDDS,
Farhad YeroshalmiDMD,
Mindaugas PraneviciusMD, and
Mana SaraghiDMD
Article Category: Other
Volume/Issue: Volume 59: Issue 3
Online Publication Date: Jan 01, 2012
DOI: 10.2344/12-00003.1
Page Range: 123 – 126