[Intubation with a double lumen tube in patients with difficult airway using endoscopy mask, and tracheal tube guide]

A 71-year-old-man with pneumothorax was scheduled for a video-assisted-thoracic-surgery. He had received subtotal resection of the mandible and was anticipated to have difficult airway. Anesthesia was induced by fentanyl, midazolam, and maintained by 0.4% isoflurane in pure oxygen. The patient was ventilated using Endoscopy Mask, having a port for fiberscopy. A fiberoptic bronchoscope and an endotracheal tube can be passed through the port without significant air leakage during positive pressure ventilation. First, a single lumen orotracheal tube was passed through the port, and Endoscopy Mask was removed. Then, a Tracheal Tube Guide was inserted through the single lumen tube. After the tube had been removed, a double lumen tube was advanced into the trachea guided by the Tracheal Tube Guide. During this procedure oxygen saturation was maintained at 100%.