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Table of Contents
Year : 2013  |  Volume : 29  |  Issue : 1  |  Page : 131-132

Malfunctioning pilot balloon assembly

1 Department of Anaesthesiology and Intensive Care, L.H.M.C, S.S.K.H and Associated Hospitals, New Delhi, India
2 Department of Anaesthesiology and Intensive Care, G.B. Pant Hospital, New Delhi, India

Date of Web Publication10-Jan-2013

Correspondence Address:
Neha Baduni
GH 12/183, Paschim Vihar, New Delhi - 110 087
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0970-9185.105829

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How to cite this article:
Baduni N, Pandey M, Sanwal MK. Malfunctioning pilot balloon assembly. J Anaesthesiol Clin Pharmacol 2013;29:131-2

How to cite this URL:
Baduni N, Pandey M, Sanwal MK. Malfunctioning pilot balloon assembly. J Anaesthesiol Clin Pharmacol [serial online] 2013 [cited 2020 Oct 27];29:131-2. Available from:


Pilot balloon assembly malfunctions are quite common, necessitating pre-operative check of even new endotracheal tubes. We are reporting a case of a pilot balloon assembly, which was normal during the pre-operative check but malfunctioned during fiberoptic intubation, due to an unusual cause.

A 52-year-old ASA I male, chronic tobacco chewer, was scheduled for laparoscopic cholecystectomy. His pre-operative investigations were all within normal limits. Airway examination revealed restricted mouth opening (1 Finger, Mallampati grade IV) due to submucous fibrosis, with normal neck movements.

An elective awake nasal fiberoptic (FOB) intubation was planned, using 'spray as you go' technique with an endotracheal tube (ETT) of 7.5 mm internal diameter, which was pre-warmed by dipping in warm saline. When the pilot balloon was inflated, it was found that even after injecting 8 cc of air, there was a significant leak. Fearing cuff damage, ETT was removed and replaced with a fresh tube under FOB guidance. The rest of the intra-operative course was uneventful.

When the faulty tube was checked, the tubing from the pilot balloon to the cuff was found to be kinked at two places [Figure 1]. Therefore, while the pilot balloon was getting inflated on injecting air, there was no inflation of the distal cuff [Figure 2] and [Figure 3]. On checking, the temperature of the saline used for dipping the tube was found to be increased. It was presumed that the pilot balloon tubing had got soft and sticky due to hot saline and its walls had got adhered at two places, thus occluding the lumen. Retrospectively, we even realized that when we were railroading the tube, it had felt quite warm.

Pre-operative check of ETT is essential to prevent equipment-related morbidity and mortality. [1] Most common cause of cuff leak is trauma to the cuff itself, which can occur during intubation. Damage to the nasotracheal tube pilot balloon has been reported; however, case reports on damage to the tubing from pilot balloon to ETT cuff are rare. [2]
Figure 1: Kinking of the tubing at two places

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Figure 2: Cuff and pilot balloon-both deflated

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Figure 3: Pilot balloon inflated, cuff deflated still

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Arya et al. have reported intra-operative cuff leak in previously checked flexometallic tube due to surface cuts over the embedded inflation tube, which became more prominent and gaped when the side of the tube on which they were present was made convex. [3]

We dipped the ETT in saline to soften it so as to decrease the chances of mucosal trauma and the incidence of epistaxis following nasotracheal intubation. [4] Pre-warming the tube also makes it more pliant to negotiate the abrupt curvature of the nasopharynx. [5] We erred in not checking the temperature of the saline solution, in which the tube was dipped, and also in not re-checking the ETT again. A re-check of ETT would have detected this and prevented re-intubation trauma to the patient.

  References Top

1.Charlton JE. Checklists and patient safety. Anaesthesia 1990;45:425-6.  Back to cited text no. 1
2.Banrios TJ, Vitale GJ. Salvage technique for a severed endotracheal cuff pilot tube. J Oral Maxillofac Surg 1997;55:100-1.  Back to cited text no. 2
3.Arya VK, Kumar A, Radhakrishnan J, Durairaju AK. All that seems well is not always well-Intermittently malfunctioning flexometallic endotracheal tubes. Br J Anaesth 2004;93:478-9.  Back to cited text no. 3
4.Lu PP, Liu HP, Shyr MH, Ho AC, Wang YL, Tan PP, et al. Softened endotracheal tube reduces the incidence and severity of epistaxis following nasotracheal intubation. Acta Anaesthesiol Sin 1998;36:193-7.  Back to cited text no. 4
5.Ying TS, Shann WH. Kinking of the endotracheal tube: An unusual complication of inserting a pre-warmed nasotracheal tube. Am J Anesthesiol 2011;12:87-90.  Back to cited text no. 5


  [Figure 1], [Figure 2], [Figure 3]

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