[Accidental left bronchial intubation with Parker Flex-Tip Tube]

In most cases, an endotracheal tube (ETT) enters the right bronchus due to anatomical features of the trachea. The Parker Flex-Tip Tube (Parker tube) has a centered and tapered tip with a posterior facing bevel. Here, we report a case of accidental left bronchial intubation that may be associated with the tip design of the Parker tube. A 43-year-old woman was scheduled for resection of an ovarian tumor. After induction of general anesthesia, the trachea was intubated using a 6.5-mm Parker tube, which was taped at the 21-cm lip line. Subsequent chest auscultation revealed a decrease in right breath sounds, and fibrotic bronchoscopy confirmed the accidental left bronchial intubation. A preoperative chest radiograph indicates no tracheal distortion. Thus, we speculated that the unusual left bronchial intubation occurred because of the ETT tip design. To test this hypothesis, we conducted a simulation study using a standard airway mannequin. Intubation with a standard left-beveled ETT resulted in right bronchial intubation in all 20 trials, while 4 of the 20 Parker tubes entered the left mainstem bronchus. This investigation suggests that unintentional left bronchus intubation of the Parker tube may occur in the ordinary clinical setting if the tube is advanced beyond the carina.