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Awake Fiberoptic Double-Lumen Intubation in Traumatic Diaphragmatic Hernia: A Case Report
Qin Hou1*
1Department of Anesthesiology, West China Hospital, Sichuan University, Sichuan, P. R. China
Corresponding Author: Qin Hou
Address: Department of Anesthesiology, West China Hospital, Sichuan University, 37 Guoxue Alley, Wuhou District, Chengdu, Sichuan 610041, P. R. China.
Received date: 04 August 2025; Accepted date: 16 August 2025; Published date: 22 August 2025
Citation: Hou Q. Awake Fiberoptic Double-Lumen Intubation in Traumatic Diaphragmatic Hernia: A Case Report. Asp Biomed Clin Case Rep. 2025 Aug 22;8(3):243-47.
Copyright © 2025 Hou Q. This is an open-access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium provided the original work is properly cited.
Keywords: Traumatic Diaphragmatic Hernia, Airway Management, Awake Fiberoptic Intubation, Double Lumen Tube
Abstract
Traumatic diaphragmatic hernia (TDH) poses significant airway management challenges due to risks of visceral herniation and respiratory compromise during positive-pressure ventilation. We present detailed use of awake fiberoptic double-lumen intubation in a 58-year-old male with left-sided TDH following a car accident. Preoperative CT imaging demonstrated a 12 cm diaphragmatic defect with gastric herniation and rightward tracheal deviation (> 15 mm displacement). Given the possible difficult airway and high aspiration risk, we implemented awake fiberoptic double-lumen intubation with topical lidocaine analgesia, maintaining spontaneous breathing without neuromuscular blockade until the hernia sac was controlled. The patient kept oxygen saturation > 95% with stable hemodynamics (BP 135–145/75–88 mmHg, HR 70–85 bpm, RR 16–20 bpm).