title: [Successful double-lumen endotracheal tube exchange with a soft-tipped extra firm exchange catheter in a patient with severe subcutaneous emphysema].
abstract: We report a case of successful double-lumen endotracheal tube exchange with a soft-tipped extra firm exchange catheter in a patient with severe subcutaneous emphysema. A 70-year-old man underwent right lower lobectomy for primary lung cancer under general anesthesia. He developed pneumothorax on postoperative day (POD) 14, which led to subcutaneous emphysema. An emergent operation was performed on POD20 to close the pulmonary fistula under general anesthesia with a single-lumen endotracheal tube and bronchial blocker. Subcutaneous emphysema became worse and pharyngeal emphysema was also suspected; re-operation to close the pulmonary or bronchial fistula was planned. We decided to place a double-lumen tube to precisely detect the fistula. Under the guide of a Pentax-AWS Airwayscope, the single-lumen endotracheal tube was exchanged uneventfully to a 35 Fr double-lumen endotracheal tube with a 110 cm soft-tipped extra firm exchange catheter. The fistula was detected by a leak test and the operation was performed uneventfully, leading to improvement of subcutaneous emphysema.
authors.forename: Kaori
authors.initials: K
authors.lastname: Okamoto
authors.forename: Nobuyasu
authors.initials: N
authors.lastname: Komasawa
authors.forename: Junichi
authors.initials: J
authors.lastname: Ishio
authors.forename: Shoko
authors.initials: S
authors.lastname: Nakano
authors.forename: Shinichi
authors.initials: S
authors.lastname: Tatsumi
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Minami
mesh_terms: D000368:Aged; D057785:Catheters; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation*; D008171:Lung Diseases / Q000150:complications / Q000601:surgery; D008175:Lung Neoplasms / Q000601:surgery; D008297:Male; D010608:Pharyngeal Diseases / Q000150:complications*; D011013:Pneumonectomy; D011183:Postoperative Complications; D012086:Reoperation; D016156:Respiratory Tract Fistula / Q000150:complications / Q000601:surgery; D013352:Subcutaneous Emphysema / Q000150:complications*