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LETTERS TO EDITOR
Year : 2019  |  Volume : 13  |  Issue : 2  |  Page : 171-172

USG-guided jelly injection: An answer to leaking cuff


1 Department of Anaesthesia, AIIMS, Patna, Bihar, India
2 Department of Dentistry, AIIMS, Patna, Bihar, India

Correspondence Address:
Dr. Chandni Sinha
Department of Anaesthesia, AIIMS, Patna, Bihar
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/sja.SJA_742_18

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Date of Web Publication19-Mar-2019
 


How to cite this article:
Kumar A, Sinha C, Kumar A, Kumari P, Mukul S. USG-guided jelly injection: An answer to leaking cuff. Saudi J Anaesth 2019;13:171-2

How to cite this URL:
Kumar A, Sinha C, Kumar A, Kumari P, Mukul S. USG-guided jelly injection: An answer to leaking cuff. Saudi J Anaesth [serial online] 2019 [cited 2019 Aug 22];13:171-2. Available from: http://www.saudija.org/text.asp?2019/13/2/171/254566



Sir,

Endotracheal tube (ETT) cuff leak is a common intraoperative problem encountered that can lead to disastrous complications such as aspiration and failure of oxygenation and ventilation.[1] Temporary interventions include pharyngeal packing, jet ventilation, and continuous air insufflations. Definitive management is the replacement of the tube, which can be cumbersome and undesirable as it involves the contamination of sterile surgical zone.

Here, we describe a new technique of sealing the cuff leak and maintaining the airway intraoperatively. A 50 year old male with pan facial injury was scheduled for plating under general anesthesia. Following orotracheal intubation, ETT was taken out through the submental opening. Midway through the surgery, we found ventilator discrepancy between the delivered and expired tidal volumes. An audible air leak noise during inspiration and the deflated pilot balloon indicated cuff leakage. Reinflating pilot balloon with air improved the ventilation only temporarily. A high-frequency linear transducer was kept transversely below the cricoid cartilage and the ETT cuff was visualized by intermittent pushing air. A 20-G needle was advanced in plane to the probe to puncture the cuff at the time of its inflation. A mixture of 2% lignocaine jelly and distilled water (ratio 1:2) was injected directly inside the cuff. A cap was applied over the needle to prevent spillage of the sealing mixture [Figure 1]. A knot on the inflating tube also served the same purpose. An adequate seal was obtained and the surgery was restarted with uneventful intraoperative period. At the end of surgery, the cuff was deflated with ease and the patient's trachea was extubated.
Figure 1: Ultrasound-guided lignocaine jelly instillation

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A similar case was reported by Bajwa et al.[2] where a mixture of lignocaine jelly and distilled water (1:1) was injected in the ruptured cuff intraoperatively by the surgeon himself. They reported difficulty in cuff deflation at the end of surgery; hence, we used a more dilute mixture.

Inflation of the ETT cuff with a lignocaine jelly–saline mixture successfully eliminated the leak, while maintaining sterility and allowing completion of the procedure without reintubation. Hence, ultrasound-guided injection of lignocaine jelly–saline mixture inside the cuff can be a useful measure during intraoperative cuff rupture.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
El-Orbany M, Salem MR. Endotracheal tube cuff leaks: Causes, consequences, and management. Anesth Analg 2013;117:428-34.  Back to cited text no. 1
    
2.
Bajwa SS, Haldar R, Kaur J. Lignocaine jelly: A simple solution to intraoperative endotracheal tube cuff leak. J Anaesthesiol Clin Pharmacol 2016;32:1  Back to cited text no. 2
    


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