Awake Double-Lumen Endotracheal Tube Intubation With Preserved Spontaneous Ventilation for Laparoscopic Repair of a Giant Type IV Hiatal Hernia: A Case Report

Induction of anesthesia in patients with giant type IV hiatal hernia can precipitate aspiration, difficult ventilation, and hemodynamic compromise. We describe a preoperative computed tomography-guided awake right-sided double-lumen tube (DLT) intubation strategy using layered topical airway anesthesia and light cooperative amnestic–analgesic sedation, with neuromuscular blockade delayed until after airway control. Transcutaneous electrical acupoint stimulation (TEAS) was applied during the pre-intubation preparation period. A 53-year-old woman tolerated awake DLT placement without cough, desaturation, or hemodynamic instability. This case emphasizes structured airway planning and preserved spontaneous ventilation in selected high-risk patients, but the independent role of TEAS remains hypothesis-generating.