Awake fiberoptic double lumen tube insertion in five patients with anticipated difficult airways

Background: Insertion of a double lumen tube in a patient with a difficult airway is a challenging procedure and requires considerable skill and experience. We performed a prospective study to assess the efficacy of awake fiberoptic intubation in patients with known difficult airways using a double lumen tube and a modified 90^o anticlockwise rotation maneuver of the tube. Materials and methods: Five patients with American Society of Anesthesiologists physical status II, aged 45-60 years, Mallampati IV and with a known difficult airway, scheduled for thoracotomy for excision of a pulmonary tumor or metastasis, were recruited for this prospective study. Following premedication and topical lidocaine spray, fiberoptic intubation was performed using a double lumen tube sliding over the fiberoptic bronchoscope after a 90^o anticlockwise rotation maneuver. We assessed the success rate of intubation, perioperative complications and side effects. Results: The double lumen tubes were successfully located in all five awake patients with no side effects or complications. Conclusions: Awake fiberoptic intubation using a double lumen tube in 5 patients with known difficult airways using a 90^o anticlockwise rotation maneuver was shown to be a safe and simple technique.