Airway leakage due to intratracheal malpositioning of an oesophageal temperature probe in an anaesthetised dog

A 10-year-old, 16.2-kg male neutered Beagle under general anaesthesia developed an airway leak following blind insertion of an oesophageal temperature probe. Before probe placement, anaesthesia was uneventful. Intubation was performed with a high-volume, low-pressure cuffed endotracheal tube. Immediately after probe placement, capnographic morphology transitioned from a normal rectangular waveform to a low-amplitude, triangular trace consistent with airway leakage. Repeated cuff inflation did not resolve the capnographic abnormalities. Reintubation revealed inadvertent tracheal placement of the temperature probe, which had presumably disrupted the cuff seal. Capnography normalised following reintubation and the procedure was completed uneventfully. This case report describes the malpositioning of an oesophageal temperature probe intratracheally, resulting in airway leakage in an anaesthetised dog. Sudden changes in capnographic waveform or a marked reduction in expected temperature following probe insertion should prompt consideration for oesophageal temperature probe malposition.