In Situ Endotracheal Tubes Letter to the Editor

Endotracheal intubation (ETI) is a simple, rapid, safe and non-surgical technique for airway manage-ment. It maintains airway patency, protects the lungs from aspiration, and permits leak-free ventilation during mechanical ventilation. The anesthesiologists ’ knowledge, technical skills and crisis management capabilities play an important role in controlling the occurrence of unwanted complications during airway management.1 In anesthesiology, leaking cuff is one of the problems occurring after correct endotracheal intubation. It usually occurs when the cuff is damaged by contact with teeth, nasal bone or Magill forceps during mechanical ventilation in which the tracheal tube should be removed and replaced. In patients with impossible manipulation of the neck, injuries to the cervical vertebrae of their neck, or difficult intubation, it is necessary to use a fiberoptic bronchoscope for reintubation most of the times. Direct laryngoscope with Macintosh blade for intubation is the first selection in cases of difficult intubation.2 Using laryngoscope produces reflex sympathetic stimulation, and subsequently increases heart rate, blood pressure, intracranial pressure, myocardial ischemia, and cardiac arrhythmia. Complications of airway problems often result in morbidity and mortality in anesthesia.1 Inadequate cuff seal is common and leads to hypoventilation during mechanical ventilation and aspiration of gastric contents. The most common cause of reintubation during anesthesia in the operating room is upper airway obstruc