Review and presentation of this case were in accordance with the Institutional Review Board at Nationwide Children's Hospital (Columbus, Ohio). The informed consent form at Nationwide Children's Hospital allows for de-identifiable information related to a patient's anesthetic care to be used for teaching and publication. Written informed consent for anesthetic care and publication was obtained from a parent prior to the procedure. A 12-year-old, 48.3 kg adolescent male with a past medical history of ADHD, generalized anxiety disorder, and behavioral issues, presented for debridement and dressing of partial-thickness burns of the trunk, bilateral extremities, and face (20-29% TBSA) with split thickness skin graft and placement of skin substrate on the face. He had been in the intensive care unit (ICU) receiving mechanical ventilation for 3 weeks prior to the procedure, with burn injury and a hospital course complicated by inhalational injury with respiratory failure, hypoxic encephalopathy, and wound infection. He was premedicated with midazolam (4mg) and transported to the OR, where standard American Society of Anesthesiologists' monitors were placed. Anesthesia was induced with propofol and maintained with sevoflurane, dexmedetomidine, and hydromorphone. Anesthetic care was uneventful until shortly before the end of the procedure when during the change of wound dressing on the face, the pilot balloon for the size 5.5 endotracheal tube in situ was inadvertently cut off (Figure 1). Immediately following this, a hemostat was placed on the remainder of the pilot cuff tubing to secure the remaining air and maintain the pressure in the cuff. Ventilation was also maintained with increased flows to compensate for air leaks. The patient remained stable, and once the dressing was secure, his trachea was re-intubated. This event led to a departmental quality improvement investigation with a literature search and development of an in vitro technique to determine an effective means to re-inflate the cuff of an endotracheal tube in the event that immediate exchange was not feasible.