A different airway management in double lumen tube intubation due to unexpected difficult airway

A difficult airway is when an experienced anesthesiologist has difficulty in providing ventilation with a mask and/or endotracheal intubation. In cases where intubation cannot be achieved with laryngoscopy, devices such as laryngeal mask airway (LMA) or fiberoptic bronchoscope (FOB) can greatly contribute to the management of the difficult airway. This process may be further complicated when direct laryngoscopy and DLT intubation fail. In this case, the first goal should be to reach the airway. For this purpose, a single-lumen tube can be used first. Although there is not yet a clear algorithm for difficult intubation in DLT insertion, the gum elastic bougie (GEB) is widely used in clinical practice for this purpose. In this case report, we wanted to highlight two of our cases in which we encountered unexpected difficult intubation and we achieved successful endobronchial intubation with FOB-guided GEB through the LMA.