Capnography-guided Identification of Ryle’s Tube Malpositioning into the Airway in an Anaesthetised Patient

Accidental airway placement of a Ryle’s tube (RT) is an important yet often overlooked cause of perioperative morbidity in anaesthetised patients. We report a case of a 56-year-old man undergoing elective lateral pancreatico-jejunostomy in whom an intraoperatively inserted RT was inadvertently placed into the trachea. Epigastric auscultation could not be performed due to a sterile surgical field, and unexpected fogging of the tube raised suspicion of malposition. Attachment of the tube to an end-tidal carbon dioxide (ETCO 2 ) monitor revealed a ventilator-synchronous capnographic waveform, confirming tracheal placement. The tube was removed and reinserted, after which the absence of CO 2 waveforms and bile-stained aspirate confirmed correct gastric placement. This case highlights the utility of capnography for rapid exclusion of airway placement.