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Fixing of a severed inflation line--a novel method.

We report a novel technique of fixing the inflation line of an intubatiog laryngeal mask airway-endotracheal tube (ILMA-ETT), which was inadvertently severed during the course of a surgical procedure. A 30-year-old, male patient (Mallampati class IV) was scheduled for surgical removal of a nasal angioflbroma. After induction of anaesthesia and muscle relaxation, endotracheal intubation was performed with a cuffed 8 mm ID ILMA-ETT through an ILMA #4. During the operation, an accidental tug led to severing of the inflation line and cuff deflation.

To reinflate the ETT cuff, a 16-gauge intravenous cannula (Mediflon[TM], with injection valve) was inserted into the severed stump of the inflation line. The needle was removed and the catheter sealed off with a luerlock stopper. The ETT cuff was inflated through the injection valve of the cannula using an air-filled syringe. The disappearance of an audible leak suggested cuff inflation. However, due to the absence of a pilot balloon, there was no visual indication of the cuff being in an inflated state. To attach the pilot balloon as well, another 16-gauge intravenous cannula (Mediflon[TM], with injection valve) was inserted into the cut end of the inflation line attached to the pilot balloon. The two intravenous cannulae were then connected using the latex tubing of an intravenous infusion set. A cuff pressure-monitoring device (Portex cuff inflator/pressure gauge) was attached to continuously monitor the ETT cuff pressure. It constantly registered a cuff pressure of ~120 cm [H.sub.2]O. The entire assembly was taped on to a piece of cardboard using adhesive tapes to stabilise the system and prevent accidental disconnection. The surgery was continued uneventfully without the risk of emergency reintubation.


This method of fixing the inflation line enabled us to attach the pilot balloon, which served as a visual indicator of the reinflated cuff. In addition, we were able to attach a device for continuous monitoring of the cuff pressure.



New Delhi, India
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Title Annotation:Correspondence
Author:Kumar, A.; Mullick, P.
Publication:Anaesthesia and Intensive Care
Geographic Code:9INDI
Date:Jun 1, 2007
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