Inflation of the Endotracheal Tube Cuff in the Pharynx for Ventilation of Paralyzed Patients with Unanticipated Difficult Airway

Airway management is essential to anesthesia practice. Despite several predictors of difficult intubation, patients with unexpectedly difficult airways are sometimes encountered, and an unforeseen grade III–IV laryngoscopy in a paralyzed patient is still a potentially dangerous situation. Several techniques and devices can be used in the face of an unplanned difficult intubation,1 such as the laryngeal mask airway, the Combitube, COPA, and light wand. However, there are situations in which these techniques and devices may not be available. There is a simple technique that will allow ventilation of the paralyzed patient for several minutes until help or alternative methods arrive. The technique involves the placement of an endotracheal tube into the pharynx, with its tip just below the epiglottis, followed by inflation of the cuff with a large volume of air. Ventilation is then performed via the endotracheal tube. To confirm the usefulness of this method, we conducted a clinical study in 50 patients with American Society of Anesthesiologists physical status I–II (27 men) undergoing general anesthesia. The hospital ethical committee approved the study, and informe