title: [Difficulty in left-sided double-lumen tube placement in patients undergoing surgical graft replacement of the descending aorta is predicted from tracheobronchial compression].
abstract: BACKGROUND
  In surgical graft replacement of the descending aorta graft, one-lung ventilation (OLV) is required to provide adequate surgical view and to allow removal of blood from the left lung. It is best to use a double-lumen tube (DLT) to assure OLV but it is sometimes difficult to place the left-sided DLT due to thoracic aneurysm or the dissection lumen. We retrospectively investigated tracheobronchial anatomy by chest X-ray and chest computed tomography (CT) in 29 cases of descending aorta replacement to determine how best to manage difficult placement of the left-sided DLT.
  
  
  METHODS
  From our database of 29 patients who had undergone descending aorta replacement between February 1, 2005, and December 31, 2009, we investigated the association between difficulty in placing the left-sided DLT and tracheobronchial anatomy by chest X-ray and CT.
  
  
  RESULTS
  We could not place a left-sided DLT in 3 of 29 cases. Two of these cases were planned surgery for aortic aneurysm and the other was an emergency operation for acute aortic dissection. We could manage the two cases safely using a right-sided DLT. We compared chest X-ray and chest CT images of these 3 cases with the other 26 cases and found that compression of the tracheobronchial tree was prevalent in the cases of difficult placement of the left-sided DLT.
  
  
  CONCLUSIONS
  We experienced difficulty in placement of the left-sided DLT in 3 of 29 cases of descending aorta replacement. We can predict difficulty of left-sided DLT placement by the presence of compression of the tracheobronchial tree on chest CT.
authors.affiliation: Department of Anesthesiology and Critical Care, Saga University, Saga 849-8501.
authors.forename: Satoko
authors.initials: S
authors.lastname: Uemura
authors.forename: Kyosuke
authors.initials: K
authors.lastname: Sugiyama
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Inoue
authors.forename: Sasagu
authors.initials: S
authors.lastname: Hamada
authors.forename: Ryo
authors.initials: R
authors.lastname: Katsuki
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Maeda
authors.forename: Mikio
authors.initials: M
authors.lastname: Nakashima
mesh_terms: D000368:Aged; D000784:Aortic Dissection / Q000601:surgery; D001013:Aorta, Thoracic / Q000601:surgery*; D001014:Aortic Aneurysm / Q000601:surgery; D019917:Blood Vessel Prosthesis Implantation; D001980:Bronchi / Q000033:anatomy & histology / Q000473:pathology*; D001995:Bronchography; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods*; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed; D014132:Trachea / Q000033:anatomy & histology / Q000000981:diagnostic imaging / Q000473:pathology*