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Bronchoscopic guide for placement of single-lung ventilation devices. A. The bronchoscope is situated in the distal trachea. In this view, the carina is
clearly visualized along with the anterior cartilaginous rings and the posterior striated membranous portion of the trachea. The takeoff of the right mainstem
bronchus is more aligned with the trachea, predisposing for endobronchal intubation of the right mainstem bronchus when an endotracheal tube is
advanced too far. The easiest way of absolutely identifying the main carina is to locate the right upper lobe (or the scar of the previously resected right
upper lobe). Confirmation of the "true" left and right mainstem bronchi is the best way to ensure proper placement of the selective lung ventilation device.
B. The bronchoscope is in the right mainstem bronchus, just proximal to the bronchus intermedius, which begins below the origin of the right upper lobe.
Source: Chapter 54. Thoracic Anesthesia, Anesthesiology, 2e
Origin of the right upper lobe is variable but usually arises 1 to 1.5 cm past the carina between 2 and 4 o'clock. C. The bronchoscope is in right upper lobe
Citation:
Longnecker
DE, Brown
Newman MF,
Zapol
WM. Anesthesiology,
2e; 2012
Available
http://mhmedical.com/
April
30,
bronchus. The
right upper
lobe branches
intoDL,
3 segments:
apical,
posterior,
and anterior. These
3 orifices
are at:
typically
arranged in a "V"Accessed:
pattern, but
they
2017
can also be oriented in a line. D. The bronchoscope is in the distal bronchus intermedius. The right middle lobe, which is to the right, immediately splits into
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the lateral and
medial ©
segments.
It is possible
to advance
a double-lumen
endotracheal tube distal enough down the right side that the endobronchial
lumen will be in the right inferior lobe and that the tracheal lumen will expose the right middle lobe. The right middle lobe's lateral segment orifice could be