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.