[Successful oral fiberoptic intubation by a double-lumen tube under the ventilation only via nostrils with a child size mask in a patient with limited mouth opening].

A 36-year-old woman was scheduled for the right lower lobe resection under the left one-lung ventilation with a double-lumen tube (DLT). Difficult intubation due to limited (1.5 cm) mouth opening was recognized following the induction of anesthesia. Fiberoptic oral intubation by the DLT was successfully performed under the ventilation via the nostrils using a small-size, child mask covering only the nose (nasal mask). Ventilation was well maintained using the nasal mask, and the gas leakage was coped with tightening the lips with the tube and using a high flow of oxygen. This nasal mask ventilation method is useful and safe in cases of difficult intubation by DLT in which no other proper methods are available.