The tip fracture of the Coopdech bronchial blocker during insertion in the patient with lung surgery

provided the original work is properly cited. CC Bronchial blockers are simple alternative methods of facilitating placement of devices for one-lung ventilation. The Coopdech bronchial blocker (Daiken Medical, Osaka, Japan) has been clinically introduced to perform one-lung ventilation with a single-lumen tracheal tube [1]. The distal tip of the Coopdech bronchial blocker has a pre-formed angulation. We experienced a case of fracture of the tip of the Coopdech bronchial blocker during insertion for one-lung ventilation. A 65-year-old female was scheduled for video-assisted thoracoscopic surgery and lung biopsy for suspected solitary pulmonary nodule in her right middle and lower lobes. Her medical history was unremarkable except for well-controlled asthma. The patient’s airway examination revealed Mallampati II and a thyromental distance of 4-finger breadths. Her chest computerized tomography revealed no abnormality of the trachea or major bronchi. Her trachea was easily intubated with a 7.5 mm internal diameter (ID) single-lumen tracheal tube (HiLo oral/nasal tracheal tube, Mallinckrodt, Athlone, Ireland). A Coopdech bronchial blocker was then inserted into the tracheal tube, and the length of the blocker was about 40 cm from the tip of the blocker to the connector of the tracheal tube. A pediatric fiberoptic bronchoscope (FI-7RBS, Pentax Medical Company, Montvale, NJ, USA) was passed through the single-lumen tracheal tube, and the tip of the blocker was visualized between the carina and the tip of tracheal tube. Despite repeated attempts under bronchoscopic guidance, the blocker could only be inserted into the left main bronchus. After removing pediatric fiberoptic bronchoscope, the tip of the bronchial blocker was rotated to the right side and then advanced blindly into the right main bronchus. After advancing the blocker for 2–3 cm, the resistance increased abruptly. Tip fracture of the bronchial blocker, which was folded backward, was visualized by reinserted pediatric fiberoptic bronchoscope. Subsequent attempts to withdraw the blocker failed because the bent tip hooked the tracheal tube. Under laryngoscopic guidance, subsequent attempts to remove both the tracheal tube and bronchial blocker also failed because the bent tip hooked the vocal cord. Both the tracheal tube and bronchial blocker were reinserted up to the carina, and the tip of the tracheal tube was positioned 2 cm above the carina, which was a relatively large space, with bronchoscopic guidance. The fractured tip of the bronchial blocker was rotated to the