[Anesthesia accidents: accidental esophageal intubation]

Accidental oesophageal intubation is a common mistake in inexperienced anaesthetists, but unrecognized oesophageal intubation is fortunately a rare event because, in anaesthetic malpractice claims, it frequently resulted in death or brain damage. The connection of these complications with the lack of experience of the anaesthetist and/or the difficult intubation is not so evident in the literature. The precocious detection of tube dislocation depends on the systematic verification of endotracheal tube position after insertion. The paper describes the clinical and instrumental tests used for detecting tracheal or oesophageal intubation. Clinical signs are often unreliable and, between technical tests, capnography is the most reliable of correct tracheal positioning if waves are regular and repeated; when unavailable, the negative pressure aspiration test is a simple and reliable alternative.