We discuss the management of anesthesia in a patient brought to hospital following a traffic accident in which she suffered distal laceration of the trachea and unstable vertebral fracture that met surgical criteria. Our main objectives were to avoid placing positive pressure on the damaged trachea and to extubate immediately after surgery. Using a left double-lumen endotracheal tube guided by flexible bronchoscope, we administered general anesthesia with mechanical ventilation and positive pressure, with no air leakage through the damaged area. Anesthesia was maintained by continuous perfusion of propofol, allowing good hemodynamic stability and rapid extubation. We conclude that this will be a useful procedure in similar cases when no other form of mechanical ventilation is available.
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