title: Retrograde orotracheal intubation with a double-lumen tube.
abstract: OBJECTIVE
  Difficult airway management in thoracic surgeries is a peculiar subject due to the demands of monopulmonary ventilation with double-lumen tubes. Flexible bronchoscopy guidance is extremely important, but it is not always available. The objective of this report was to describe a case of retrograde selective orotracheal intubation in the absence of specific endoscopy equipment for the procedure.
  
  
  METHODS
  This is a patient with a history of retosigmoidectomy, admitted for a right thoracotomy for a lung lesion. Preoperative anesthetic evaluation did not reveal any clinical and physical exam particularities. After anesthetic induction and ventilation with face mask, two attempts of orotracheal intubation under direct laryngoscopy were ineffective due to difficult visualization of the vocal folds (Cormack-Lehane grade III). Due to the unavailability of specific material for selective endoscopic intubation it was decided to use the retrograde technique using the double-lumen tube. The patient was extubated in the operating room shortly after the end of the surgery without complications secondary to the alternative technique.
  
  
  CONCLUSIONS
  Retrograde selective orotracheal intubation is a minimally invasive technique, low cost, safe, and extremely useful whenever flexible bronchoscopy is not available.
authors: Serviço de Anestesiologia of Hospital São Lucas, PUCRS, Porto Alegro, Brazil.
authors: Jayme da Rocha
authors: Jda R
authors: Heck
authors: Frederico Krieger
authors: FK
authors: Martins
authors: Maria Teresa Ruiz
authors: MT
authors: Tsukazan
authors: Vivian
authors: V
authors: Cristofoli
authors: Maurício
authors: M
authors: Pipkin
authors: Marner Lopes
authors: ML
authors: da Silveira
authors: Jayme de Oliveira
authors: Jde O
authors: Rios
authors: José Antônio Lopes de Figueiredo
authors: JA
authors: Pinto
mesh_terms: D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation* / Q000379:methods*; D008297:Male; D008875:Middle Aged