2019 Volume 39 Issue 2 Pages 125-130
Tracheal deviation is often recognized in preoperative radiography. Although most of these cases are asymptomatic, mediastinal shift and rotation occasionally cause airway compression. We report our experience in the management of right bronchial stenosis aggravated by left upper lobectomy.
Preoperative chest radiography in a 71-year-old woman with lung abscess of the left upper lobe revealed destruction of the left upper lobe and tracheal displacement to the left. Chest computed tomography and fiber bronchoscopy showed right bronchial compression from the vertebral body, and sleeping difficulty in the supine position was observed. The induction and maintenance of anesthesia were uneventful, but postoperatively there was a sudden rise in airway resistance and a marked decrease in tidal volume while in the supine position. Fiber bronchoscopy showed exacerbation of right bronchial compression. We hypothesized that the left upper lobectomy aggravated the tracheal deviation and right bronchial stenosis. Because the right bronchus was compressed from posterior to anterior, we moved the patient to a sitting position and reversed neuromuscular blockade, which resulted in decreased airway resistance and adequate ventilation. Anesthesiologists should be aware that tracheal deviation can cause airway stenosis, and that preoperative evaluation and airway management therefore require careful consideration.
