Journal of Clinical Anesthesia RSS feed: Current Issue. The Journal of Clinical Anesthesia (JCA) addresses all aspects of anesthesia practice, including anesthetic administration, pharmacokinetics, preoperative and postoperative considerations, coexisting disease and other complicating factors, cost issues, and similar concerns anesthesiologists contend with daily. Exceptionally high standards of presentation and accuracy are maintained. The core of the journal is original contributions on subjects relevant to clinical practice, and rigorously peer-reviewed. Highly respected international experts have joined together to form the Editorial Board, sharing their years of experience and clinical expertise. Specialized section editors cover the various subspecialties within the field. To keep your practical clinical skills current, the journal bridges the gap between the laboratory and the clinical practice of anesthesiology and critical care to clarify how new insights can improve daily practice. JCA is affiliated with four societies that make it their official journal: Society for Education in Anesthesia ( SEA ); the American Association of Clinical Directors ( AACD ); the Society for Airway Management (SAM); and the Orthopedic Anesthesia Pain Rehabilitation Society ( OAPRS ). Visit JCA Online at URL: http://www.JCAfulltextonline.com/ http://www.jcafulltextonline.com/?rss=yesElsevier Inc.en © 2009 Published by Elsevier Inc. All rights reserved. Journal of Clinical Anesthesia0952-8180218December 2009 © 2009 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.jcafulltextonline.com/article/PIIS0952818009003122/abstract?rss=yesEditorial Board10.1016/S0952-8180(09)00312-2Journal of Clinical Anesthesia 21, 8 (2009)2009-12-01Journal of Clinical Anesthesia2009-12-01218S0952-8180(09)X0009-7iiihttp://www.jcafulltextonline.com/article/PIIS0952818009003134/abstract?rss=yesTable of Contents10.1016/S0952-8180(09)00313-4Journal of Clinical Anesthesia 21, 8 (2009)2009-12-01Journal of Clinical Anesthesia2009-12-01218S0952-8180(09)X0009-7iiiivhttp://www.jcafulltextonline.com/article/PIIS0952818009002670/abstract?rss=yesAbstract: Study Objective: To characterize the accuracy of clinician knowledge of anesthesia drug and equipment costs at one institution.Design: Anonymous survey instrument.Setting: Large academic medical center.Measurements: 130 questionnaires were sent to departmental practitioners, including residents, CRNAs, and attendings. An updated list of acquisition costs for commonly used drugs and equipment is posted on our departmental website and is sent to all clinical staff by electronic mail annually. For each item, the respondent was given a choice of price ranges and indicated the range in which they believed the actual cost of the item to be. Accuracy was calculated as the difference between the identifier of the correct and chosen ranges. The mean and variance of these differences were then calculated for each item within each practitioner group and tested to identify statistically significant differences among practitioner groups.Main Results: A total of 103 (79%) completed questionnaires were received. Many practitioners overestimated or underestimated the actual costs of most of the items. There was no significant difference between the groups for the mean accuracy across the entire set of items. For variance in price estimation, there was a statistically significant greater variance only for CA1 residents compared with attendings, CRNAs, and CA3 residents.Conclusions: Many experienced practitioners in an academic setting lack accurate knowledge of the acquisition costs of common drugs and supplies.Cost awareness among anesthesia practitioners at one institutionDavid B. Wax, Jason Schaecter10.1016/j.jclinane.2008.12.029Journal of Clinical Anesthesia 21, 8 (2009)2009-10-26Journal of Clinical Anesthesia2009-10-26218S0952-8180(09)X0009-7Original contributions547550http://www.jcafulltextonline.com/article/PIIS0952818009002621/abstract?rss=yesAbstract: Study Objective: To determine the difference in performance of two different auditory evoked potentials (AEP) monitors, the A-Line AEP (AAI) and the aepEX, and their indices, during general anesthesia.Design: Prospective study.Setting: Operating room at a private hospital.Patients: 40 ASA physical status I and II women, aged 30 to 70 years, scheduled for partial mastectomy.Interventions: Anesthesia was induced with propofol and fentanyl, and a Laryngeal Mask Airway (LMA) was inserted. Anesthesia was maintained with propofol, fentanyl, and nitrous oxide.Measurements and Main Results: The AAI or the aepEX was continuously monitored and their performance was compared at the start of monitoring, at LMA insertion, after disturbance by electric cautery, and during anesthesia. Eighteen of 20 patients had low enough impedance to extract good electroencephalogram signals at the first electrode application with the A-Line AEP, and 14 of 20 patients, with the aepEX. The time to return to good signals after signal disturbance by electric cautery was 14 ± 3 seconds (SD) with the AAI and 19 ± 4 seconds (SD) with the aepEX (P = 0.035). Both AAI and aepEX decreased after anesthesia induction, with significantly lower values seen in AAI than the aepEX.Conclusions: The A-Line AEP (AAI) is better detects the response to painful stimuli and during recovering from noise of electric cautery than the aepEX. The aepEX shows higher values than the AAI during propofol-fentanyl-nitrous oxide anesthesia.Comparison of the two different auditory evoked potentials index monitors in propofol-fentanyl-nitrous oxide anesthesiaTomoki Nishiyama10.1016/j.jclinane.2008.12.024Journal of Clinical Anesthesia 21, 8 (2009)2009-10-26Journal of Clinical Anesthesia2009-10-26218S0952-8180(09)X0009-7Original contributions551554http://www.jcafulltextonline.com/article/PIIS0952818009002657/abstract?rss=yesAbstract: Study Objective: To examine the effects of landiolol on the QT interval, rate-corrected QT (QTc) interval, QT dispersion (QTD), and rate-corrected QTD (QTcD) during tracheal intubation using computerized measurement.Design: Randomized, double-blinded study.Setting: Dokkyo Medical University Hospital operating room.Patients: 30 ASA physical status I patients scheduled for elective surgery.Inventions: Patients were randomized to receive either normal saline (saline group) or landiolol (landiolol group; one-min loading infusion of 0.125 mg/kg followed by 0.04 mg/kg/min infusion). Immediately after the start of administration of saline or landiolol, anesthesia was induced with intravenous (IV) fentanyl two μg/kg, propofol 1.5 mg/kg, and vecuronium 0.1 mg/kg. Six minutes after administration of saline or landiolol, tracheal intubation was performed within 20 seconds.Measurements: Mean arterial pressure (MAP), RR interval, QT interval, QTc interval, QTD, and QTcD were consecutively recorded during the induction.Main Results: There was no significant difference in MAP between groups during the study. RR interval in the landiolol group was significantly longer than in the saline group from two minutes after the start of the landiolol infusion to the end of the study. The QT interval in the landiolol group was significantly shorter than in the saline group from start of the infusion to 4 minutes after tracheal intubation. The QTc interval, QTD, and QTcD in the landiolol group were significantly shorter than those in the saline group from immediately after tracheal intubation to the end of study.Conclusion: A bolus of landiolol 0.125 mg/kg followed by an infusion of landiolol 0.04 mg/kg/min may reduce the risk of cardiac arrhythmias during induction of anesthesia.Effects of landiolol on QT interval and QT dispersion during induction of anesthesia using computerized measurementMizue Kaneko, Shigeki Yamaguchi, Shinsuke Hamaguchi, Hirotoshi Egawa, Koichi Fujii, Kazuyoshi Ishikawa, Toshimitsu Kitajima, Junichi Minami10.1016/j.jclinane.2008.12.027Journal of Clinical Anesthesia 21, 8 (2009)2009-10-23Journal of Clinical Anesthesia2009-10-23218S0952-8180(09)X0009-7Original contributions555561http://www.jcafulltextonline.com/article/PIIS0952818009002669/abstract?rss=yesAbstracts: Study Objective: To study the effect of left heart bypass (LHB) on regional pulmonary blood flow and arterial oxygenation during one-lung ventilation (OLV).Design: Prospective, observational studySetting: Operating roomPatients: 14 ASA physical status II and III patients scheduled to undergo descending thoracic or thoracoabdominal aortic surgery using LHB.Interventions and Measurements: Parameters studied during OLV with 100% oxygen before and during LHB mean arterial pressure, heart rate, pulmonary artery pressure, pulmonary capillary wedge pressure, central venous pressure, cardiac index, cardiac output, arterial oxygen tension (PaO2), mixed venous oxygen pressure, alveolar arterial oxygen difference (P(A-a)O2), and right upper pulmonary venous flow (RUPVF). Right upper pulmonary venous flow was measured using transesophageal echocardiography.Main Results: With the transition to OLV, there was a significant decrease in PaO2 and a significant increase in P(A-a)O2. However once LHB was initiated, these values improved significantly (P = 0.0007 and 0.0004, respectively) with the simultaneous increase in RUPVF (P = 0.0018).Conclusions: LHB improved pulmonary blood flow to the dependent lung and arterial oxygenation during OLV in descending thoracic aortic surgery.The effect of left heart bypass on pulmonary blood flow and arterial oxygenation during one-lung ventilation in patients undergoing descending thoracic aortic surgeryKoichi Yuki, Chieko Sakuramoto, Chieko Matsumoto, Mariko Hoshino, Yoshinari Niimi10.1016/j.jclinane.2008.12.028Journal of Clinical Anesthesia 21, 8 (2009)2009-10-26Journal of Clinical Anesthesia2009-10-26218S0952-8180(09)X0009-7Original contributions562566http://www.jcafulltextonline.com/article/PIIS0952818009002785/abstract?rss=yesAbstract: Study Objective: To identify risk factors for reversible psychomotor dysfunction after prolonged sedation with isoflurane during mechanical ventilation in the intensive care unit (ICU).Design: Retrospective case series.Setting: General ICU at Tonami General Hospital.Measurements: The records of 335 patients, aged from 10 months to 93 years, who were sedated with isoflurane for more than 12 hours, were reviewed. The presence or absence of reversible psychomotor dysfunction after weaning from mechanical ventilation during isoflurane sedation, and its type and duration, if present, were recorded. Data on patients’ demographics, duration of isoflurane inhalation, minimum alveolar concentration (MAC)-hours of isoflurane, and concomitant medical treatments were recorded.Result: Twelve patients (3.6%) developed reversible psychomotor dysfunction, including systemic or localized tremor, chorea, and hallucination, which lasted 10 minutes to 6 days after weaning from mechanical ventilation during isoflurane sedation. Such psychomotor dysfunction occurred in 42% (8 of 19) of patients aged 4 years or less, while only in 1.3% (4 of 316) of those older than 4 years (P < 0.0001). It occurred in 0% (none of 167) of patients receiving isoflurane for 24 hours or less, while in 7.1% (12 of 168) of patients receiving it for more than 24 hours (P = 0.0004). Other factors examined, including gender, MAC-hours, and drugs co-administrated with isoflurane, did not affect its incidence.Conclusion: Four years of age or less and isoflurane inhalation for more than 24 hours were considered to be significant risk factors for the development of reversible psychomotor dysfunction after prolonged sedation with isoflurane.Risk factors for the development of reversible psychomotor dysfunction following prolonged isoflurane inhalation in the general intensive care unitJun Ariyama, Masakazu Hayashida, Keizo Shibata, Yuji Sugimoto, Hirokazu Imanishi, Yoshiyuki O-oi, Akira Kitamura10.1016/j.jclinane.2009.01.011Journal of Clinical Anesthesia 21, 8 (2009)2009-10-26Journal of Clinical Anesthesia2009-10-26218S0952-8180(09)X0009-7Original contributions567573http://www.jcafulltextonline.com/article/PIIS0952818009002803/abstract?rss=yesAbstract: Study Objective: To investigate the efficacy of preoxygenation by eight deep breaths in 60 seconds with the Mapleson A (Magill) system, the circle anesthesia system, or the Mapleson D system at an oxygen flow of 5 L/min or 10 L/min.Design: Randomized, clinical study.Setting: Operating room of a university hospital.Subjects: 10 healthy volunteers.Interventions: Volunteers underwent 6 preoxygenation trials consisting of 8 deep breaths in 60 seconds using the Mapleson A, Mapleson D, and the circle anesthesia systems at an oxygen flow of 5 L/min and 10 L/min.Measurements: Fractional end-tidal oxygen concentration (FETO2) was measured at 15-second intervals during preoxygenation.Results: At an oxygen flow of 10 L/min, mean FETO2 values at 60 seconds of preoxygenation were comparable among the Mapleson A, Mapleson D, and the circle anesthesia systems (87 ± 2.1%, 87 ± 1.6%, 87 ± 1.6%, respectively). Using an oxygen flow of 5 L/min, mean FETO2 values at 60 seconds were similar among the Mapleson A, Mapleson D, and circle anesthesia systems (74 ± 4.1%, 75 ± 2.6%, 74 ± 4.4%, respectively); however, they were significantly lower than the corresponding values achieved at an oxygen flow of 10 L/min.Conclusions: The 8-deep-breaths in 60 seconds technique at an oxygen flow of 10 L/min can achieve adequate preoxygenation with the Mapleson A (Magill), Mapleson D, and circle anesthesia systems. Suboptimal preoxygenation is obtained with the three systems when the oxygen flow used is 5 L/min.Preoxygenation by 8 deep breaths in 60 seconds using the Mapleson A (Magill), the circle system, or the Mapleson D systemSamar K. Taha, Mohamad F. El-Khatib, Sahar M. Siddik-Sayyid, Faraj W. Abdallah, Carla M. Dagher, Jules-Marie A. Chehade, Anis S. Baraka10.1016/j.jclinane.2009.01.013Journal of Clinical Anesthesia 21, 8 (2009)2009-10-26Journal of Clinical Anesthesia2009-10-26218S0952-8180(09)X0009-7Original contributions574578http://www.jcafulltextonline.com/article/PIIS0952818009002797/abstract?rss=yesAbstract: Study Objective: To investigate the quality of cell salvaged (CS) blood in patients undergoing hemihepatectomy (study group) and compare it with CS-blood from aortic surgery (control group).Design: Observational study.Setting: Operating room in a university hospital.Measurements: 6 patients undergoing hemihepatectomy or aortobifemoral bypass with intraoperative blood loss of more than 800 mL. Samples were drawn from the central venous catheter, from the reservoir of a CS recovery system, and from the processed blood in each patient to determine interleukin (IL)-6, IL-8, IL-10, tumor necrosis factor (TNF), complement C3a, and the terminal complement complex C5b-9. Microbiological analysis included colony count after cultivation in aerobic and anaerobic medium as well as enrichment culture for 6 days.Main Results: In the hemihepatectomy group, levels of IL-6, C3a, and C5b-9 were significantly higher in the reservoir than in samples obtained from the central venous catheter. After the washing procedure, levels of IL-6, C3a, and C5b-9 were lower in the liver resection group than in each patient's own plasma levels. In all patients undergoing aortobifemoral bypass and in 5 patients undergoing hemihepatectomy, blood samples were sterile or showed growth of commensal skin microflora in low numbers (coagulase-negative staphylococci or propionibacteria). In one patient in the liver resection group, we could not exclude contamination with intestinal flora.Conclusion: Cell salvaged blood in liver resection seems to be safe for retransfusion with respect to cytokine release and complement activation, but requires further investigation in regard to bacterial contamination.Is cell salvage safe in liver resection? A pilot studyAnnette Schmidt, Harald C. Sues, Ekkehard Siegel, Dirk Peetz, Anders Bengtsson, Hendrik W. Gervais10.1016/j.jclinane.2009.01.012Journal of Clinical Anesthesia 21, 8 (2009)2009-10-26Journal of Clinical Anesthesia2009-10-26218S0952-8180(09)X0009-7Original contributions579584http://www.jcafulltextonline.com/article/PIIS0952818009002827/abstract?rss=yesAbstract: Study Objective: To characterize the complications reported with intravenous regional anesthesia (IVRA).Design: Literature search.Setting: University-affiliated hospital.Measurements: A search was done in the American National Library of Medicine's PUBMED, EMBASE (1980-2007, wk 11), and Medline (from 1950) in March 2007. All complications associated with IVRA were reviewed.Main Results: The lowest dose of local anesthetic associated with a seizure was 1.4 mg/kg for lidocaine; 4 mg/kg for prilocaine, and 1.3 mg/kg for bupivacaine. Cardiac arrests and deaths were reported with lidocaine and bupivacaine only. The lowest dose associated with a cardiac arrest was 2.5 mg/kg for lidocaine and 1.6 mg/kg for bupivacaine. Local anesthetic toxicity occurring during tourniquet inflation has been reported, with tourniquet pressure exceeding initial systolic arterial blood pressure by 150 mmHg. Seizures occurring after tourniquet deflation have been reported with a tourniquet time as long as 60 minutes. Ten cases of compartment syndrome are reported.Conclusion: Seizures have been reported with lidocaine at its lowest effective dose (1.5 mg/kg).Adverse events associated with intravenous regional anesthesia (Bier block): a systematic review of complicationsJoanne Guay10.1016/j.jclinane.2009.01.015Journal of Clinical Anesthesia 21, 8 (2009)2009-10-26Journal of Clinical Anesthesia2009-10-26218S0952-8180(09)X0009-7Original contributions585594http://www.jcafulltextonline.com/article/PIIS0952818009002608/abstract?rss=yesAbstract: A case of postoperative epidural hematoma with an atypical presentation and an excellent outcome in an 80 year-old woman who received both prophylactic aspirin and enoxaparin following a primary total knee arthroplasty, is presented. She developed lower limb neurological symptoms, fully recovered, and then deteriorated again. The hematoma was surgically evacuated, resulting in full neurological recovery. Epidural analgesia may not be the best choice for pain management in patients who require the combined use of aspirin and low-molecular weight heparin postoperatively.Atypical presentation of an epidural hematoma in a patient receiving aspirin and low molecular weight heparin. Was epidural analgesia the right choice?Shilpa V. Kasodekar, Eric Goldszmidt, Sharon R. Davies10.1016/j.jclinane.2008.12.022Journal of Clinical Anesthesia 21, 8 (2009)2009-10-23Journal of Clinical Anesthesia2009-10-23218S0952-8180(09)X0009-7Case reports595598http://www.jcafulltextonline.com/article/PIIS095281800900261X/abstract?rss=yesAbstract: Multidetector ECG-gated CT angiography permits imaging of structures such as the coronary arteries and pulmonary veins with peripheral administration of contrast media. Respiratory motion artifact limits the applicability of this technique in critically ill patients due to an inability to cooperate with prolonged breath holds necessary for quality images. A case in which high-frequency jet ventilation via an uncuffed tracheostomy tube in an unmedicated patient permitted respiratory immobilization sufficient to acquire diagnostic images, is presented.Use of high-frequency jet ventilation for respiratory immobilization during coronary artery CT angiographyJeff E. Mandel, Ivan Perry, William W. Boonn, Harold Litt10.1016/j.jclinane.2008.12.023Journal of Clinical Anesthesia 21, 8 (2009)2009-10-28Journal of Clinical Anesthesia2009-10-28218S0952-8180(09)X0009-7Case reports599601http://www.jcafulltextonline.com/article/PIIS0952818009002712/abstract?rss=yesAbstract: Interrupting anticoagulation in patients at high risk for thromboembolism, even for critically important surgery, may lead to devastating outcomes. The patient described developed "Locked-in Syndrome" from basilar arterial thrombosis within 24 hours of withholding anticoagulation for urgent airway surgery. Emergency thrombolysis partially restored arterial flow, with recovery of some function. The dangers of hemorrhage during surgery must be balanced against the potentially devastating consequences of withholding anticoagulation in patients at high risk for thrombosis.Perioperative management of acute ischemic stroke: a case reportHla Phon, Jeremy Jaffe, Jay Horrow10.1016/j.jclinane.2009.01.010Journal of Clinical Anesthesia 21, 8 (2009)2009-10-26Journal of Clinical Anesthesia2009-10-26218S0952-8180(09)X0009-7Case reports602605http://www.jcafulltextonline.com/article/PIIS0952818009002682/abstract?rss=yesAbstract: A neonate developed red man's syndrome and stridor following perioperative administration of vancomycin. The medical management of stridor and red man's syndrome are presented.Stridor accompanying red man's syndrome following perioperative administration of vancomycinJesus Apuya, E.F. Klein10.1016/j.jclinane.2009.01.007Journal of Clinical Anesthesia 21, 8 (2009)2009-10-26Journal of Clinical Anesthesia2009-10-26218S0952-8180(09)X0009-7Case reports606608http://www.jcafulltextonline.com/article/PIIS0952818009002815/abstract?rss=yesAbstract: Two patients in whom the bispectral index (BIS) decreased to zero following cardiac arrest during cardiothoracic surgery are described. The BIS value decreased to zero after cardiac arrest, and the value remained low for the remainder of the anesthetic despite successful cardiopulmonary resuscitation. Both patients were found to have severe brain injuries in the postoperative period.Predicting ischemic brain injury after intraoperative cardiac arrest during cardiac surgery using the BIS monitorPatrick G. Goodman, Anand R. Mehta, Manuel R. Castresana10.1016/j.jclinane.2009.01.014Journal of Clinical Anesthesia 21, 8 (2009)2009-10-30Journal of Clinical Anesthesia2009-10-30218S0952-8180(09)X0009-7Case reports609612http://www.jcafulltextonline.com/article/PIIS0952818009002840/abstract?rss=yesDr B is an advocate of the use of hyperthermia for palliative cancer treatment. Dr B ran a clinic in California that is one of only 5 or 6 major U.S. institutions that perform hyperthermia. Based in large part on his own research, Dr B claimed that hyperthermia with and without radiation given daily and more often can have beneficial effects, and can also result in lower per-treatment radiation amounts, thus extending the time the patient can receive radiation.Benefits notwithstanding: discipline associated with efficacious medical treatmentBryan A. Liang10.1016/j.jclinane.2009.11.001Journal of Clinical Anesthesia 21, 8 (2009)2009-12-01Journal of Clinical Anesthesia2009-12-01218S0952-8180(09)X0009-7Doctor's docket613615http://www.jcafulltextonline.com/article/PIIS0952818009002748/abstract?rss=yesThe tracheal tube introducer (bougie) is widely used to facilitate difficult intubation. However, single-use introducers, compared to reusable ones, appear to be more traumatic .Airway injury caused by a Portex single-use bougieChryssoula Staikou, Alexia A. Mani, Argyro G. Fassoulaki10.1016/j.jclinane.2009.03.006Journal of Clinical Anesthesia 21, 8 (2009)2009-10-26Journal of Clinical Anesthesia2009-10-26218S0952-8180(09)X0009-7Letters to the Editor616617http://www.jcafulltextonline.com/article/PIIS0952818009002736/abstract?rss=yesBag-mask ventilation is a basic life support skill for every medical practitioner in general, and for every anesthesiologist in particular. The correct facemask (FM) holding technique is crucial for effective mask ventilation, prevention of high airway pressure and stomach dilatation, and prevention of early fatigue of the operator.The rotated mask holdAzriel Perel, Haim Berkenstadt, Yacob Yusim, Tiberiu Ezri10.1016/j.jclinane.2009.03.005Journal of Clinical Anesthesia 21, 8 (2009)2009-10-26Journal of Clinical Anesthesia2009-10-26218S0952-8180(09)X0009-7Letters to the Editor617618http://www.jcafulltextonline.com/article/PIIS0952818009002761/abstract?rss=yesObesity continues to dramatically increase in the United States. Obese and morbidly obese patients are at high-risk for difficult airway management, cardiopulmonary dysfunction, aspiration, and markedly increased perioperative morbidity and mortality . Because of this increased risk, body mass index (BMI) over 45 kg.m−2 is considered a contraindication for outpatient surgery .Is obesity a cause of surgical cancellation in outpatient surgery center?Jeffrey Huang10.1016/j.jclinane.2009.03.008Journal of Clinical Anesthesia 21, 8 (2009)2009-10-26Journal of Clinical Anesthesia2009-10-26218S0952-8180(09)X0009-7Letters to the Editor618618http://www.jcafulltextonline.com/article/PIIS0952818009002724/abstract?rss=yesWe report a hazardous technical problem that occurred with two Ambu AuraFlex single-use Laryngeal Mask Airways (LMAs; Intavent-Orthofix, Maidenhead, UK) consecutively during an ear, nose, and throat (ENT) case.Laryngeal Mask Airway failureMoein Tavakkolizadeh, Joanne Glynn10.1016/j.jclinane.2009.03.004Journal of Clinical Anesthesia 21, 8 (2009)2009-10-30Journal of Clinical Anesthesia2009-10-30218S0952-8180(09)X0009-7Letters to the Editor618619http://www.jcafulltextonline.com/article/PIIS095281800900275X/abstract?rss=yesManagement of the airway is an important aspect of emergency medicine, anesthetic practice, and intensive care. The ideal method of securing a definitive airway is by endotracheal intubation. In acute emergencies, securing the airway can be difficult. Accidental damage to the endotracheal tube (ETT) cuff, pilot balloon, and pilot tube can be catastrophic. Damage to pilot tubes may be salvaged using various methods. Yoon et al. used a needle connector to attach the pilot balloon to the pilot tube. Whitesides and Exler used a jelco cannula attached to the pilot tube to inflate the ETT cuff and used a surgical clamp to prevent the cuff from deflating.Endotracheal pilot tube: a salvage techniqueSanthosh Gopalakrishnan, Rajashekar Gowni10.1016/j.jclinane.2009.03.007Journal of Clinical Anesthesia 21, 8 (2009)2009-10-30Journal of Clinical Anesthesia2009-10-30218S0952-8180(09)X0009-7Letters to the Editor619620http://www.jcafulltextonline.com/article/PIIS0952818009002839/abstract?rss=yesAcknowledgment of Reviewers, Volume 21, 200910.1016/j.jclinane.2009.10.001Journal of Clinical Anesthesia 21, 8 (2009)2009-11-02Journal of Clinical Anesthesia2009-11-02218S0952-8180(09)X0009-7Acknowledgment of Reviewers Volume 21621626http://www.jcafulltextonline.com/article/PIIS0952818009003304/abstract?rss=yesAuthor Index for Volume 21, 200910.1016/S0952-8180(09)00330-4Journal of Clinical Anesthesia 21, 8 (2009)2009-12-01Journal of Clinical Anesthesia2009-12-01218S0952-8180(09)X0009-7e1e5http://www.jcafulltextonline.com/article/PIIS0952818009003316/abstract?rss=yesKeyword Index for Volume 21, 200910.1016/S0952-8180(09)00331-6Journal of Clinical Anesthesia 21, 8 (2009)2009-12-01Journal of Clinical Anesthesia2009-12-01218S0952-8180(09)X0009-7e7e9