Successful One-lung Ventilation with Hyperflex™ Tracheostomy Tube and Endobronchial Blocker in a Post-Chemoradiation Oesophageal Cancer Patient with Glottic Oedema - A Case Report

Post-radiation airway changes pose significant challenges for lung isolation during thoracic surgery. We report successful management of an unanticipated difficult airway in a patient undergoing esophagectomy, where standard intubation succeeded but proved inadequate for surgical requirements – a 68-year-old female with post-neoadjuvant therapy oesophageal carcinoma presented with unexpected glottic narrowing during anaesthetic induction. Intubation was successfully achieved with a 6.5 mm endotracheal tube; however, this proved insufficient for lung isolation and adequate ventilation requirements during major thoracic surgery. Strategic conversion to a hyperflex tracheostomy tube with EZ-blocker placement enabled successful one-lung ventilation for 3 h and 10 min. This case demonstrates that successful intubation does not guarantee adequate surgical conditions in patients who have undergone radiation therapy. Hyperflex tracheostomy tubes with bronchial blockers provide reliable alternatives when double-lumen tubes cannot be placed, achieving high success rates in the hands of experienced practitioners.