9. Miracle of a syringe attached to the pilot balloon of endotracheal tube during neurosurgical procedures

Background: The use of cuff inflating syringe in situ results in preventing airway related complications during neurosurgical procedures in various positions. Materials and Methods: It is a prospective study including all neurological surgeries done under GA from 2000. The parameters noted were duration of anesthesia and a standard 10 ml of air is used to inflate the cuff to prevent air leak, the remaining amount of air in syringe is noted and the amount of air left in situ is noted at the end of procedure. Results: In 20% of patients there was an increase in air volume of which 5-10% increase was noted in 2 hrs, 20-25% in 2-4 hrs and up to 50% for surgeries lasting more than 5-6 hrs. We had 5 patients of which 3 patients who had air leak during posterior cervical surgeries and 2 patients had complete tube blockade at bevel end of the ET tube. Conclusion: Securing and maintaining the ET tube in long duration procedures and positions other than supine can be difficult as the patency of tube can be compromised also the added risk of using nitrous oxide which can diffuse into the cuff increasing its volume and pressure. Complications like tube blockade at bevel end, hoarseness, laryngeal edema, vocal cord edema, accidental extubation and ventilator malfunction can be prevented. The simple technique of leaving the cuff inflating syringe can help to avoid airway catastrophe as the airway is inaccessible during the procedure.

No conflict of interest has been declared by the author(s).