Intraoperative Repair of Pilot Balloon Inflation Line Damage: A Practical Solution to Tube Replacement

Intraoperative damage to the pilot balloon inflation line of an endotracheal tube (ETT) can result in cuff deflation, leading to ineffective ventilation and increased aspiration risk. This case report describes a practical repair technique that allowed continued saf e ventilation without tube replacement. A 70-year-old woman underwent elective coronary artery bypass grafting. During central venous catheter placement, the anesthesia machine displayed low etCO₂ and ventilator failure alarms. Diminished bilateral breath sounds were noted, and the pilot balloon was found severed. As the patient's hemodynamics remained stable, a 20G intravenous catheter steel needle t ip was inserted directly into the inflation line, carefully positioned to avoid further damage. The cuff was reinflated using a syringe, and appropriate pressure was maintained with a three-way stopcock and cuff manometer. The air leak resolved, and surgery proceeded without requiring tube exchange. Pilot balloon damage can be safely managed intraoperatively using readily available equipment. This practical approach may serve as a valuable alternative to endotracheal tube replacement, especially in cases involving a difficult airw ay. Familiarity with such repair methods can enhance airway safety during surgery.