The Effect-Site Concentration of Remifentanil for Prevention of Increase of Blood Pressure and Heart Rate to Tracheal Intubation during Propofol-Remifentanil Total Intravenous Anesthesia in Korean / 대한마취과학회지

BACKGROUND: Combination of propofol and remifentanil is an ideal regimen for total intravenous anesthesia. The purpose of this study is to determine the effect-site concentration of remifentanil for prevention of hemodynamic responses to tracheal intubation during fixed propofol infusion (4microgram/ml) and to find any sexual differences. METHODS: Thirty ASA physical status I-II patients undergoing general anesthesia were assigned to male (n = 15), and female (n = 15) group. All patients received a target controlled infusion (TCI) of propofol with a fixed effect-site concentration of 4microgram/ml. After target effect-site concentration of propofol and remifentanil was reached, tracheal intubation was performed. The hemodynamic changes (systolic/diastolic blood pressure, mean arterial pressure, and heart rate) were measured at 1 and 2 min before tracheal intubation (baseline), immediately after, 1, 2, 3, 4 and 5 min following tracheal intubation. In both groups, effect-site concentration of remifentanil was initiated with 3 ng/ml. Subsequent concentration of remifentanil was determined by hemodynamic responses of the previous patient to tracheal intubation based on up and down sequential allocation. RESULTS: The mean EC50 of remifentanil for prevention of hemodynamic responses to tracheal intubation were 1.37 ng/ml (95% CI, 0.95-1.81 microgram/ml) in male group and 1.05 microgram/ml (95% CI, 0.68-1.40 ng/ml) in female group, respectively. In addition, there were no statistical significant differences between two groups. CONCLUSIONS: Relatively small dosages of remifentanil (0.68-1.81 microgram/ml) for attenuation of hemodynamic responses to tracheal intubation was needed in Korean population in propofol TCI and there were no sexual differences.

The Effect-Site Concentration of Remifentanil for Prevention of Increase of Blood Pressure and Heart Rate to Tracheal Intubation during Propofol-Remifentanil Total Intravenous Anesthesia in Korean / 대한마취과학회지

BACKGROUND: Combination of propofol and remifentanil is an ideal regimen for total intravenous anesthesia. The purpose of this study is to determine the effect-site concentration of remifentanil for prevention of hemodynamic responses to tracheal intubation during fixed propofol infusion (4microgram/ml) and to find any sexual differences. METHODS: Thirty ASA physical status I-II patients undergoing general anesthesia were assigned to male (n = 15), and female (n = 15) group. All patients received a target controlled infusion (TCI) of propofol with a fixed effect-site concentration of 4microgram/ml. After target effect-site concentration of propofol and remifentanil was reached, tracheal intubation was performed. The hemodynamic changes (systolic/diastolic blood pressure, mean arterial pressure, and heart rate) were measured at 1 and 2 min before tracheal intubation (baseline), immediately after, 1, 2, 3, 4 and 5 min following tracheal intubation. In both groups, effect-site concentration of remifentanil was initiated with 3 ng/ml. Subsequent concentration of remifentanil was determined by hemodynamic responses of the previous patient to tracheal intubation based on up and down sequential allocation. RESULTS: The mean EC50 of remifentanil for prevention of hemodynamic responses to tracheal intubation were 1.37 ng/ml (95% CI, 0.95-1.81 microgram/ml) in male group and 1.05 microgram/ml (95% CI, 0.68-1.40 ng/ml) in female group, respectively. In addition, there were no statistical significant differences between two groups. CONCLUSIONS: Relatively small dosages of remifentanil (0.68-1.81 microgram/ml) for attenuation of hemodynamic responses to tracheal intubation was needed in Korean population in propofol TCI and there were no sexual differences.

Prolonged Horner's Syndrome following Stellate Ganglion Block: A case report / 대한통증학회지

Stellate ganglion block, due to its wide range of indications, is the most widely practiced procedure in pain clinics. We experienced the case of a 44-year-old female patient who developed prolonged Horner's syndrome after the use of stellate ganglion block. The patient recovered spontaneously from the Horner's syndrome after 12 months. If Horner's syndrome should occur, its etiology will need to be assessed. It is also important to assure the patient they will recover from the complication within a year.

Chest Pain due to an Aortic Pseudoaneurysm during Trans-Urethral Resection of the Prostate: A case report / 대한마취과학회지

Aortic pseudoaneurysms are rare. When aortic pseudoaneurysms are detected, they demand timely surgical intervention because they trend to increase in size and cause complications. We experienced a rare case of a chronic traumatic pseudoaneurysm located at the distal descending aorta associated with chest pain during trans-urethral resection of the prostate under spinal anesthesia. Diagnostic testing led to appropriate management.

Hemodynamic Changes Measured by Esophageal Doppler Monitor during Laparoscopic Cholecystectomy and Gynecologic Pelviscopy / 대한마취과학회지

BACKGROUND: Laparoscopic cholecystectomy and gynecologic pelviscopy need to induce pneumoperitoneum to allow visualization of the operative field, but the former requires a head-up position whereas the latter needs a Lithotomy-Trendelenburg position. The authors observed hemodynamic changes using an esophageal doppler monitor in both cases. METHODS: Eight females planned for laparoscopic cholecystectomy were assigned to Group 1 and 10 females for gynecologic pelviscopy were assigned to Group 2. Thiopental (5 mg/kg) and vecuronium (0.1 mg/kg) were used to induce general anesthesia. 50% O2-N2O and 1.5 vol.% isoflurane were used to maintain anesthesia. Mechanical ventilation was used with a tidal volume of 10 ml/kg and a respiratory rate of 12 breaths per minute. Mean arterial pressure, heart rate, end-tidal CO2 and peak airway pressure were measured and cardiac output, corrected flow time, and peak velocity were monitored using an esophageal doppler monitor in each group after inducing anesthesia, CO2 inflation, position change, and CO2 deflation. RESULTS: Mean arterial pressure increased in each group while changing position. No significant changes in the heart rate were observed in each group. End-tidal CO2 increased in each group after changing position, and remained elevated even with position reversal and deflation. Peak airway pressure was elevated in each group after CO2 inflation and increased more so with changing posture in group 2 (post inflation: 18.5 +/- 1.4 cmH2O, after position change: 21.4 +/- 2.0 cmH2O). Cardiac output and cardiac index were reduced after the induction of pneumoperitoneum in each group, and reduced more on changing posture in group 2 (CO: 5.9 +/- 2.0 L/min vs. 4.4 +/- 1.5 L/min, CI: 3.7 +/- 1.4 L/min/m2 vs. 2.7 +/- 1.1 L/min/m2). Stroke volume also reduced after changing posture in each group. Corrected flow time was not changed, but peak velocity decreased after CO2 inflation in each group (group 1: 97.4 +/- 30.0 cm/s vs. 78.9 +/- 27.3 cm/s, group 2: 111.9 +/- 14.1 cm/s vs. 88.3 +/- 12.6 cm/s). CONCLUSIONS: The Lithotomy-Trendelenburg position can augment the hemodynamic changes resulting from pneumoperitoneum. Therefore, additional caution is required in patients with cardiovascular disease who are undergoing gynecologic pelviscopy.

The Effect of Skull Pin Fixation on Cerebrospinal Fluid Pressure and Cerebral Perfusion Pressure: Influence of Lidocaine and Fentanyl / 대한마취과학회지

BACKGROUND: A hypertensive response is seen when a skull pin is inserted for a craniotomy. The risk of morbidity and mortality is high in patients with intracranial pathology. Many methods have been introduced to overcome the problem. We compared the hemodynamic effects and changes of intracranial pressure when we used lidocaine or fentanyl for blunting the hypertensive response. METHODS: Thirty-two patients scheduled for a craniectomy were divided into two groups: an IV (intravenous) bolus of fentanyl (2micro gram/kg) group or lidocaine (1.5 mg/kg) group. An anesthesia was induced with fentanyl (2micro gram/kg), thiopental (5-7 mg/kg), lidocaine (1.5 mg/kg) and vecuronium (0.1 mg/kg), and was maintained with isoflurane 1 MAC (minimum alveolar anesthetic concentration) in nitrous oxide 50% and oxygen. After induction of anesthesia, a lumbar subarachnoid catheter was inserted for CSFP (cerebrospinal fluid pressure) measurement. An IV bolus of either fentanyl (2micro gram/kg) or lidocaine (1.5 mg/kg) was administered prior to insertion of the skull pin by a randomized method. CSFP, MAP (mean arterial pressure), and HR (heart rate) were measured before and 5 min after induction of anesthesia, immediately before and each mininute for five measurements after skull pin insertion. RESULTS: There were no intergroup differences in the values of CSFP and HR. The MAP increased 9+/-14 (mean+/-SD) mmHg and 4+/-12 (mean+/-SD) mmHg 1 min after the skull pin insertion compared with immediately before skull pin insertion in the fentanyl group and lidocaine group respectively. The MAP recovered 2 min after the skull pin insertion in both groups. CPP (cerebral perfusion pressure) recovered 3 min and 2 min after the skull pin insertion in the fentanyl group and lidocaine group respectively. CONCLUSIONS: An IV bolus of either fentanyl or lidocaine before skull pin insertion resulted in a stable value of CSFP, CPP and HR.

A clinical consideration of submental intubation at oral and maxillofacial surgery

Conversion to Normal Sinus Rhythm by Propofol during Electrical Cardioversion in Atrial Flutter and Idiopathic Ventricular Tarchycardia / 대한마취과학회지

There are a few case reports describing conversion to normal sinus rhythm after a propofol injection in tachyarrhythmic patients. We managed two cases of 52 year old males complaining of chest pain and dyspnea. We diagnosed them with atrial flutter and idiopathic ventricular tachycardia respectively. Initially they were treated with antiarrhythmic drugs but conversion to normal sinus rhythm was not achieved. Therefore, we decided to use electrical cardioversion. For sedation during electrical cardioversion, we injected propofol 2 mg/kg and 2% lidocaine 1 mg/kg. A few seconds later, conversion to normal sinus rhythm was achieved without electrical cardioversion in both cases. Thereafter normal sinus rhythm continued on the ECG and they were discharged.

The Effect of Tissue pH Values of a Wound on Pain Behaviors in an Acute Pain Model of the Rat / 대한마취과학회지

BACKGROUND: There is a suggestion that tissue acidosis may contribute to the induction of pain in inflammation and ischemia. High local proton concentrations have been found in painful inflammatory and ischemic conditions. We assessed tissue pH and pain behavior in a rat model for postoperative pain. METHODS: An incision of skin, fascia, and muscle was performed in the right foot. Pain behaviors to von Frey, blunt probe stimulation, and resting pain were evaluated on the incised feet. Then tissue pH was measured in each of the five rats at 4 hours, 1, 2, 4, and 7 days after incision. RESULTS: The withdrawal threshold to von Frey was decreased, the response frequency to blunt probe and pain scores were elevated from 4 hours to 1 - 2 days after the incision. The deep tissue pH decreased from pH 7.16 in sham to pH 6.95, 6.90, 6.89, and 6.95 at 4 h and 1, 2, and 4 days after incision respectively. CONCLUSIONS: In this study, the tissue pH of the wound decreased after surgery. However, the change of tissue pH was not always consistent with pain behaviors. Our results suggest that tissue acidosis may relate partially to the induction of pain after tissue injury.

Submental Orotracheal Intubation for Maxillofacial Surgery: A case report / 대한마취과학회지

Airway management for patients who have suffered multiple facial fractures and skull base fractures is complicated. Nasal intubation can interfere with centralization and stabilization of nasal fractures and may lead to cranial intubation. Restoring the dental occlusion by means of intraoperative maxillo- mandibular fixation is a prerequisite to the corrrect anatomical reduction of multiple facial fractures. This fixation precludes oral endotracheal intubation. In the past, it has been overcome by a tracheostomy. Complications of a tracheostomy include infection, hemorrhage, subcutaneous emphysema, pneumothorax, pneumomediastinum, recurrent laryngeal nerve damage, tracheal stenosis, and tracheoesophageal fistula. The technique of submental intubation was originally described by Altemir. This technique provide secure airway, an unobstructed intraoral airway field. and allows maxillomandibular fixation while avoiding the drawbacks and complications of naso-endotracheal intubation or tracheostomy. With this technique, the multiple facial fractures were corrected successfully.

The Effect of Doxazosin Premedication on Urinary Retention after Epidural Morphine / 대한마취과학회지

BACKGROUND: Urinary retention is the most common and distressing complication in the postoperative period after an epidural morphine administration. In this prospective placebo-controlled study, the efficacy of doxazosin on preventing urinary retention after epidural morphine was investigated. METHODS: A total of 75 males who underwent elective arthroscopic knee surgery were randomized into three groups. Patients in group I received a placebo orally before surgery. Group II patients received 4 mg of doxazosin, and group III patients received 8 mg of doxazosin. In all patients, 2 mg of epidural morphine in 6 ml normal saline was administrated by the epidural route in the L3-4 interspace. General anesthesia was induced in all patients. The volumes of the first two postoperative urine voidings, the time intervals between the end of surgery and the first micturition and the need for bladder catheterization were recorded. RESULTS: There were statistically no significant differences among the groups in the first two postoperative voidings (Group I 449 ml/445 ml, Group II 343 ml/388 ml, Group III 376 ml/380 ml). No significant differences were noted among the three groups in the mean time between the end of the surgery and the first micturition (Group I 467 minutes, Group II 440 minutes, Group III 366 minutes). Also, with urinary catheterization, there were no differences among the groups (G I6/25, G II 5/25, G III 7/25). CONCLUSIONS: Prophylactic use of doxazosin does not prevent postoperative urinary retention after epidural morphine.

The Effects of Transection Injury and Local Infiltration of Phenol at the Sciatic Nerve on c-fos Expression in the Spinal Cords of Rats / 대한마취과학회지

BACKGROUND: Phenol has effects like surgical neurectomy, but may evoke pain after local infiltration in nerves. Transection of peripheral nerves may induce neuropathic pain through increased spontaneous discharge and other mechanisms. Proto-oncogene, c-fos, is an indicator of neuronal activity, and its expression in the spinal cord may be related to pain development, because inhibition of c-fos expression has corresponding effects like analgesia. We evaluated the effects of local infiltration of phenol and transection injury at the sciatic nerve on c-fos expression in the spinal cords of rats. METHODS: Sixteen male Sprague-Dawley rats were divided into 2 groups; transection of the sciatic nerve was performed for group 1; phenol was infiltrated into the sciatic nerve in group 2. Three hours, 1 week, 2 weeks, and 3 weeks after the experiment, the corresponding spinal cord was stained immunohistochemically for c-fos. RESULTS: c-fos was expressed from 3 hours to 2 weeks over the laminae of the dorsal horn in each group. Phenol increased the expression of c-fos initially, but decreased 1 week later. Transection injury did not increase it initially, but showed the peak expression at 1 week, and maintained it for 2 weeks. Therefore, it seems that phenol, rather than the transection injury, stimulates c-fos expression early, but decreases later. CONCLUSIONS: Phenol treatment, caused by chemical block due to protein denaturation and nonspecific inflammation, may induce less neuropathic pain than the transection of a nerve.

Effect of Continuous Epidural Block on the Duration of Intensive Care after Cardiac Surgery / 대한구급학회지

BACKGROUND: Continuous epidural block after surgery has been able to get better postoperative analgesic effect than intermittent intravenous (IV) opioids and to decrease the duration of mechanical ventilatory support, endotracheal intubation and ICU stay. The purpose of this study is to observe these effects of continuous epidural block after cardiac surgery. METHODS: 30 patients, undergoing cardiac surgery, were divided into 2 groups. Postoperative analgesia were performed by intermittent IV meperidine 25 mg in group 1 and by continuous epidural block with 1% mepivacaine 100 ml and morphine 4 mg in group 2. Both groups were supplemented, at the patient's request, by IV meperidine 25 mg as needed. Quality of pain relief, total number of IV meperidine and duration of consciousness return, mechanical ventilatory support, endotracheal intubation, ICU stay were compared between 2 groups. RESULTS: Quality of pain relief and total number of IV meperidine were significantly lower in group 2 than group 1, each time interval. Duration of consciousness return, mechanical ventilatory support, endotracheal intubation, ICU stay and time interval between consciousness return & mechanical ventilatory support were significantly shorter in group 2 than group 1. CONCLUSIONS: Continuous epidural block, with 1% mepivacaine 100 ml and morphine 4 mg, for postoperative analgesia decreases the duration of intensive care compaered with intermittent IV meperidine 25 mg, after cardiac surgery.

Resistance to Cerebrospinal Fluid Outflow Measured by Bolus Injection Method in Normal Adults

No abstract available.

The Effect of Propofol on Blood Pressure and Heart Rate during Induction of Anesthesia and Endotracheal Intubation in Patients with Sinus Bradycardia / 대한마취과학회지

BACKGROUND: Bradycardia frequently occurs in intravenous anesthesia with propofol. Patients with sinus bradycardia have increased vagal tone at rest. The purpose of this study is to evaluate the effect of propofol on blood pressure and heart rate during induction of anesthesia in patients with sinus bradycardia. METHODS: Sixteen adult patients were studied. No anticholinergics were used before induction. Anesthesia was induced intravenously with midazolam 0.03 mg/kg, propofol 2 mg/kg, lidocaine 1 mg/kg and vecuronium 0.12 mg/kg. Anesthesia was maintained with continuous infusion of propofol 150 microgram/ kg/min and 100% O2. Hemodynamic data were recorded 3 minutes after midazolam injection, immediately after propofol injection, 1 and 2 minutes after propofol continuous infusion, and immediately, 1, 3 and 5 minutes after intubation. RESULTS: Heart rate significantly increased after intravenous injection of propofol (P < 0.05) and was maintained during the study. There was no incidence of bradycardia. CONCLUSIONS: Anesthesia induction and maintenance with propofol could be a suitable and safe ansethetic method for patients with sinus bradycardia.

Comparison of the Plasma Concentrations of Nalbuphine after Epidural and Intravenous Administration / 대한마취과학회지

BACKGROUND: Nalbuphine is one of the opioid agonist-antagonists and is used frequently in the anesthetic field. Usage is focused on potent analgesic action and the adjuvant of narcotics because of less complications with preserved analgesia. The most common routes of administration for postoperative pain control are epidural and intravenous, so we compared both pharmacokinetic profiles. METHODS: Twelve patients were randomly divided into two groups. All patients were given a spinal anesthesia with tetracaine hydrochloride. One group (n = 6) received nalbuphine 10 mg via epidural route and another group (n = 6) received the same dose via intravenous route. Venous blood was drawn at 0, 0.25, 0.5, 1, 2, 4, 6 and 8 hours to measure plasma nalbuphine concentrations. Analysis was performed by high performance liquid chromatography with an electrochemical detector. RESULTS: At 0.25 hour, the plasma concentration of nalbuphine was significantly higher in the epidural administration group (49.48 +/- 4.98 ng/ml) than in the intravenous administration group (40.44 +/- 1.64 ng/ml). At 6 and 8 hours, the plasma concentration of nalbuphine was significantly higher in the epidural administration group (5.98 +/- 1.86 ng/ml, 3.85 +/- 0.94 ng/ml) than in the intravenous administration group (3.80 +/- 0.33 ng/ml, 2.43 +/- 0.32 ng/ml). Clearance, elimination half life, volume of distribution and AUC were not significantly different between the two groups. CONCLUSIONS: The plasma concentrations of nalbuphine via epidural route and intravenous route were similar in both groups after 0.25 hour to 6 hours. At 0.25 hour and after 6 hours, the epidural administration group had a higher plasma concentration of nalbuphine than the intravenous administration group.

Can Neck Crease be Used as an Indicator of C6 Level in Stellate Ganglion Block? / 대한마취과학회지

BACKGROUND: Stellate Ganglion Block (SGB) is a procedure performed frequently in pain clinics. However the palpation of cervical transverse processes is difficult in patients with short and thick necks. In these cases the neck crease is used as an indicator of cervical level in my department. The aim of this study is to evaluate the usefulness of neck creases as an indicator of C6 level. METHODS: We observed fifty patients that experienced nerve blockade due to chronic pain or cancer-related pain. Patients laid down in supine position. They slightly elevated their chins and opened their mouths to relax neck muscles. A) The radiopaque line was laid in accordance with neck crease below the thyroid cartilage. B) Simultaneously, the radiopaque indicator was laid on the skin above the most prominent tubercle by palpation. We took an x-ray picture of the neck. RESULTS: The probability that the lines crossed over C5, C6 and C7 were 16%, 71%, and 12% respectively. The probability that the most prominent tubercle accorded with C5, C6 and C7 were 16%, 69% and 14% respectively. There was no significant difference between method A) and B). CONCLUSIONS: The most prominent palpable tubercle of the cervical spine can be used as an indicator of C6, but we can use the neck crease as a good indicator of C6 in cases where the neck can't be palpated well.

Comparison of Train-of-four Response between Adductor Pollicis and Orbicularis Oculi to Determine the Optimal Time for Endotracheal Intubation after Vecuronium Administration / 대한마취과학회지

BACKGROUND: Ideal condition of endotracheal intubation after administration of non-depolarizing muscle relaxants like vecuronium is the time when the diaphragm and upper airway muscles are completely relaxed. But these muscles are difficult to determine the degree of relaxation. Neuromuscular response of these muscles are similar to that of orbicularis oculi (OO), but adductor pollicis (AP) is different. However, it is sometimes difficult to monitor OO response. The purpose of this study was to monitor the upper airway muscle relaxation using AP other than OO. METHODS: Fourty-four adult patients of ASA class 1 schaduled for elective surgery under general anesthesia were examined. Anesthesia was induced with fentanyl 2 mcg/kg, and 2 minutes later followed by thiopental sodium 5 mg/kg. After supramaximal stimulation for control twitch height, vecuronium 0.1 mg/kg was intravenously injected and applied continuous train-of-four (TOF) facial nerve stimuli. The TOF response of OO was closely observed with examiner's naked eyes. When complete relaxation of OO achieved, TOF ratio of AP and the time after vecuronium injection were recorded. Thereafter, tracheal intubation was performed and the intubating condition scores was recorded. Ulnar nerve stimuli were continuously applied until complete relaxation of AP was achieved. The time of complete relaxation of AP after vecuronium injection was also recorded. RESULTS: The onset time of complete relaxation was significantly faster in OO (181.3+/- 47.4 secs) as compared with that of AP (265.0+/-67.8 secs). The average TOF ratio of AP was 47.3+/-17.2% and the condition of intubation performed after complete relaxation of OO was satisfied. CONCLUSION: The optimal time for endotracheal intubation was about 3 min after vecuronium 0.1 mg/kg injection, when TOF ratio of AP was about 50%.

Effective Low Dose of Buprenorphine in Continuous Epidural Administration for Postoperative Pain Control / 대한마취과학회지

BACKGROUND: Buprenorphine is more potent and has less side effects than morphine. Therefore it can be used instead of morphine in cancer or postoperative pain contol. The aim of this study was to find an effective low dose of buprenorphine in epidural administration for pain control after obstetric-gynecologic surgery. METHODS: Epidural catheters were placed at L2-3 or L3-4 epidural space in all groups. Sixty nine patients were randomized to three epidural infusion group M, B1 and B2. Each group was 23. Group M: 3 mg morphine with 0.5% bupivacaine 10 ml as bolus, morphine 7 mg in 0.125% bupivacaine 100 ml in infusor; group B1: 0.068 mg buprenorphine with 0.5% bupivacaine 10 ml as bolus, buprenorphine 0.17 mg in 0.125% bupivacaine 100 ml in infusor; group B2: 0.11 mg buprenorphine with 0.5% bupivacaine 10ml as bolus, buprenorphine 0.24 mg in 0.125% bupivacaine 100 ml in infusor. Pain score, side effects and frequency of adjuvant analgesics were recorded at postoperative 1, 2, 6, 12, 24 and 48 hours. RESULTS: There was statistically significant difference of pain score at postoperative 1, 2 and 12 hrs in group B1 (p<0.05). Frequency of adjuvant analgesic was significantly increased in group B1. But there was no significant difference between group M and B2 in pain score. CONCLUSIONS: Our results suggest that buprenorphine 0.11 mg as bolus and 0.24 mg for 2 days are the optimal dose in continuous epidural administration for postoperative pain contol.

Incidence of Malposition and it's Affecting Factors of Left-Sided Double-Lumen Endotracheal Tube / 대한마취과학회지

Backgroud: In one-lung ventilation using the left-sided double-lumen tube (LDLT), it is important to place the LDLT in correct position to maintain adequate ventilation. We investigated the frequency of and the factors affecting the LDLT malposition in endotracheal intubation. Methods: Ninety one (55 male and 36 female) patients were observed. After endotracheal intubation, using 35 and 37 Fr. sized Robertshaw type LDLT, auscultation and fiberoptic bronchoscope were performed to make sure the correct position of LDLT. The heights, weights, age, and sex were noted. The lengths and diameters of trachea, and the angles and diameters of both bronchi on chest x-ray were measured for comparison. Results: Normal in auscultation and gross malposition were 87.9% and 12.1%. Among those normal in auscultation, normal in bronchoscope, advancing and removing fine malposition were 66.2%, 18.8% and 15.0%, respectively. The angle of left bronchus is 37.71+/-4.60degrees in normal in ausculation and 37.71+/-4.60degrees in gross malposition. The length of trachea is 13.41+/-0.90 cm in normal in bronchoscope, 14.49+/-0.78 cm in advancing fine malposition and 11.86+/-0.35 cm in removing fine malposition. The patient's height is 167.27+/-7.12 cm in normal in brochoscope, 172.45+/-6.67 cm in advancing fine malposition and 163.12+/-6.54 cm in removing fine malposition. Conclusions: The angle of left bronchus is a factor affecting gross malposition. And the length of trachea and the patient's height are factors affecting fine malposition. Thus it is necessary to obtain in advance information on patient's height, length of trachea and angle of left bronchus on chest x-ray, to reduce the occurrence of the LDLT malposition.