A novel intubation technique for tracheoesophageal fistula in adults

To describe a novel technique of tracheal intubation and ventilation in an adult patient with a large tracheoesophageal fistula at the level of the carina. A 59 yr old woman with squamous cell carcinoma of the esophagus developed a large (2 cm diameter) tracheoesophageal fistula after radiotherapy. The level of her fistula precluded traditional use of a double-lumen endobronchial tube. Intubation and ventilation were managed with two endobronchial tubes. The ability to ventilate or collapse each lung individually was preserved and anesthesia and surgery proceeded uneventfully. Double endobronchial intubation is described to manage anesthesia in an adult patient with a tracheoesophageal fistula at the level of the carina.