To the Editor-We would like to propose an improvement to our original method of intubation presented in 1992. [1] We originally proposed first inserting an endotracheal tube into the esophagus, then pulling the tube back into the pharynx until breath sounds are audible. The cuff is then inflated, and [2,3] the nasogastric tube is passed into the larynx through the endotracheal tube. At this point, the Rusch tube can be inserted into the trachea together with the nasogastric tube after deflating the cuff. Now we would like to recommend an alteration for situation in which the nasogastric tube is mistakenly inserted into the esophagus. When this occurs the endotracheal tube cuff should be deflated, the tube advanced into the esophagus, and rotated approximately 180 [degree sign]. It should then be withdrawn until breath sounds are heard, and the nasogastric tube is then reinserted. We emphasize the importance of rotating of Rusch endotracheal tube in the esophagus because most failures may occur when the tip of the endotracheal tube, when drawn back from the esophagus, is located on the improper side of the pharynx to permit passage of the nasogastric tube. Following this recommendation, we have found the success rate to be greatly improved.
Naoki Sugiura, D.D.S.
Department of Oral and Maxillofacial surgery
Morimasa Yamada, M.D., D.D.S.; Motoshi Kainuma, M.D.; Toshiyuki Miyake, M.D.
Department of Anesthesiology; Fujita Health University School of Medicine; Toyoake, Aichi 470–11, Japan
(Accepted for publication March 31, 1997.)
