[General anesthesia in a orthopedic case with the Kommerell's diverticulum of right-sided aortic arch diagnosed on preoperative examination].

Kommerell's diverticulum is a rare anomaly of the aortic arch. A 59-year-old man was scheduled for open reduction and internal fixation of his right proximal tibial fracture under general anesthesia. We diagnosed right-sided aortic arch by the chest X-ray and thoracic computed tomography. His trachea and esophagus were compressed by the aortic arch. He had complained of no dyspnea or dysphagia. Respiratory difficulty might be caused by muscle relaxants, intermittent positive pressure ventilation, change of intrathoracic pressure, postural change and overloaded infusion during general anesthesia in a case of right-sided aortic arch. We performed lumbar epidural anesthesia and inserted an i-gel after general anesthesia induction preserving spontaneous respiration in preparation for controlled ventilation or tracheal intubation via an i-gel. We could accomplish the operation uneventfully and he was discharged on POD 53. A supraglottic airway such as an i-gel was a useful device in the present case of right-sided aortic arch with Kommerell's diverticulum.