To the Editor: A 55-yr-old patient with a history of laryngeal squamous cell cancer that required a total laryngectomy, cervical esophagectomy with gastric pull-up, and bilateral neck dissection presented to the operating room for a pectoralis muscle flap 7 days after the original operation. The posterior wall of his distal trachea had developed ischemic and infectious ulcerations, and the surgical team was concerned about placing an endotracheal tube (ETT) in the tracheal stoma for fear of further damage. After anesthetizing the distal trachea with a 4% lidocaine suspension, we elected to selectively intubate both mainstem bronchi under fiberoptic guidance with two cuffed inner diameter 5.5 mm ETTs. To prevent collapse of the right upper lobe, the right ETT was bronchoscopically placed so that the Murphy eye was directed toward the takeoff of the right upper lobe bronchus. Both ETTs were sutured to the patient's chest wall and connected with a double-lumen ETT connector (Broncho-Cath[registered sign]; Mallinckrodt Medical Inc, St. Louis, MO) to the breathing circuit (Figure 1). Postoperatively, the system remained in place for 24 h before extubation. Three days later, respiratory failure required reintubation, which was performed as described above, in the intensive care unit.Figure 1: Double-lumen endotracheal connector attached to two pediatric endotracheal tubes.Fiberoptic placement of the ETTs through the patient's tracheal stoma and their connection as described created a double-lumen ETT that was very helpful in the management of this patient. J. Douglas Glass, MD Diane S. Ellis, MD Burkhard F. Spiekermann, MD Robin J. Hamill, MD Department of Anesthesiology; University of Virginia Health Sciences Center; Charlottesville, VA 22906