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Background: Oral & faciomaxillary surgeries are challenging as anesthesiologist share airway with surgeon. For these surgeries general Anaesthesia is required. Endotracheal intubation is gold standard for general Anaesthesia in various oral& faciomaxillary surgeries. Detection of endotracheal intubation is crucial as missed esophageal intubation is disaster. Normally wave capnography is used for detecting endotracheal intubation. Use of Ultrasound in field of anaesthesia is getting popular since few years. We use ultrasound for detecting endotracheal intubation. Study design: Randomised comparative observational study. Aims & objectives: To access efficacy of real time ultrasound to detect endotracheal tube in situ. Also to compare it with wave capnography for real time, efficacy, missed esophageal intubation, accuracy, specificity, sensitivity. Methods: We have enrolled 60 patients in 2 groups, 30 in each group by odd and even numbers in sealed opaque envelopes randomly. Execution of randomization was done at time of giving general anaesthesia. Group A: Ultrasound was used to detect endotracheal intubation. Group B: Wave capnography is used for detecting endotracheal intubation. Time to access, missed esophageal intubation, accuracy, specificity and sensitivity were noted. Results: Out of 60 patients, 3 esophageal intubation were there. Out of 57 tracheal intubation USG assess one as esophageal intubation (false positive). Conclusion: Ultrasound is good alternative to ETCO2 to confirm endotracheal tube even in remote setup. Ultrasound Guided Confirmation of Endo Tracheal Intubation in Various Oral & Faciomaxillary Surgeries ARC Journal of Dental Science Page | 17 In Group A ETT confirmation done by capnography and in Group B ETT confirmed by USG. Patients below 18years of age, Mallampatti Grade 3 or 4, obese, patients with restricted neck movement were excluded. After routine pre anaesthetic check up and written informed consent, patients were taken inside ot. A large bore i.v cannula was inserted and all routine monitors were attached. Premedication in form of Inj. Ondansetron 4mg iv slowly, Inj. Glycopyrrolate 0.1g iv, Inj. Fentanyl 1.5μg/kg iv given. General anaesthesia was given Inj. Thiopentone 6 mg/kg and Succinylcholine 2 mg/kg and Endto tracheal tube inserted according to patients age. Confirmation of Endotracheal tube was done clinically Auscultation, Etco2 Capnography and Ultrasound. Under US, after intubation linear probe was placed horizontally over suprasternal region. Trachea, Tracheal ring and esophagus were identified. If tube is inside the trachea, two hyperechoic parallel lines are seen, Single lumen imaging can be seen; in presence of esophageal intubation, the trachea is empty with a distended esophagus and Double lumen imaging can be seen. Successful tracheal intubation was verified using the following criteria: identification of the trachea and tracheal rings, visualization of vocal cord, widening of glottis as the tracheal tube passes through, tracheal tube positioning above carina and demonstration of movement of visceroparietal pleural interface after manual ventilation of the lungs [5]. Esophageal intubation was recognized by visualization of the tube in the left paratracheal space. Endtidal CO2 was measured by a wave form capnography. It was accepted that Endotracheal intubation was present if the value after at least five ventilations was greater than 4mmhg in wave form capnography and if characteristic waveform was present. Time taken Wave form Capnography and US were recorded. All patients were auscultate over right and left hemithorax and Epigastric region. In auscultation, right and/or left breathing sound was accepted as Endotracheal intubation and breathing sound over Epigastric region considered as Esophageal intubation.