We report a case of bronchial rupture associated with use of a double-lumen endobronchial tube(DLT). A 52-year-old, previously healthy female was scheduled for thoracoscopic left upper lobectomy. Physical examination was unremarkable. After anesthesia was induced, her trachea was intubated easily with a 35-Fr left sided DLT(Blue Line endobronchial tube®, Smiths Medical Japan, Tokyo). Surgery proceeded uneventfully under general anesthesia using oxygen, air, sevoflurane, and remifentanyl. Post-lobectomy, when the airway pressure was increased for a leak test, we observed an air leak from mediastinum. The bronchial tip of the DLT was observed in mediastinum through the thoracoscope, and we found that the DLT ruptured the membranous portion at the root of the left main bronchus. An urgent open thoracotomy was performed to repair the bronchial injury, but otherwise she had an uneventful recovery. In conclusion, anesthesiologists should be alerted to the risk of tracheobronchial rupture associated with use of a DLT.
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