Case report demonstrates successful awake fiberoptic double-lumen intubation in a patient with traumatic diaphragmatic hernia, highlighting airway management challenges and risks.
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).
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Qin Hou (2025) studied this question.
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