Insertion of the double lumen tube in the difficult airway.

Isolation of a lung and one-lung ventilation are commonly used during thoracic surgery. Insertion of double lumen tubes requires considerable skill and may be especially challenging in the difficult airway. We describe a method of inserting double lumen tubes in two patients with known difficult airways. This technique involves awake nasotracheal intubation followed by insertion of an oral double lumen tube under general anaesthesia.