• Hiromi Yamase, Sigeru Ogawa, Satoshi Fujimori, and Tadasu Kohno.
• Department of Anesthesiology, Toranomon Hospital, Tokyo 104-8470.
• Masui. 2010 May 1; 59 (5): 652-6.

BackgroundIt is more difficult to intubate the double-lumen bronchial tube into the left bronchus than the right bronchus, and it is more difficult in a left decubitus position than normal position. And it is most difficult in the flexional decubitus position.MethodsWe examined the cause of the difficulty in intubation of the left main bronchus which is solved by 3DCT.ResultsThe cause of the difficulty was the increase in size of the divergence angle of the left bronchus. Once the double-lumen left bronchial tube in the left bronchus has been pulled out, it is difficult to return the tube back to the left bronchus in the flexional position. For returning the tube to the bronchus, we place the head higher and change the flexional position to the extended position.ConclusionsWe examined the cause of difficulty in intubation of the left bronchus in the decubitus position with 3DCT. We concluded that the cause is the increase in the size of the angle, and for the tube to be intubated in the left bronchus, the patient position must be changed from the flexional position.

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