Abstract
A 47-year-old male patient (161cm, 40kg) was scheduled for video-assisted thoracotomy. After anesthesia induction, we attempted to intubate a #35 left double lumen bronchial tube. The tube tip was inserted through the glottis, but it was not able to progress, because there appeared strong resistance. A #32 double lumen tube and a 6.5 mm ID single lumen tube were resulted in the same difficulty. The ProSeal type of laryngeal mask #4 was placed and successfully instituted positive pressure ventilation. The surgery was performed while ventilation was interrupted when necessary without any complications. Postoperative examinations revealed a history of tracheostomy for a suicidal attempt several years ago. The surgical scar in the anterior neck at the level of 4-5 tracheal cartilage was confirmed, and the 11 mm of tracheal diverticulum at the level of the previous tracheostomy.
