Journal of Medical Academics

Register      Login

VOLUME 3 , ISSUE 2 ( July-December, 2020 ) > List of Articles

Original Article

Observational Analysis of Changes in Endotracheal Tube Cuff Pressure During Laparoscopic Surgery

Hunsehalli Revanasiddappa Narendra, Aparna Nerurkar, Shibu Sasidharan

Keywords : Endotracheal tube, Laparascopic surgery, N2O, Pneumo-peritoneum,Cuff pressure

Citation Information : Narendra HR, Nerurkar A, Sasidharan S. Observational Analysis of Changes in Endotracheal Tube Cuff Pressure During Laparoscopic Surgery. Journal of Medical Academics 2020; 3 (2):46-49.

DOI: 10.5005/jp-journals-10070-0052

License: CC BY-NC 4.0

Published Online: 08-03-2021

Copyright Statement:  Copyright © 2020; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Background: Laparoscopic surgery is performed under general anesthesia with mechanical ventilation, and a high-volume, low-pressure endotracheal tube (ETT) with a sealing cuff pressure about 20–30 cm of H2O is commonly used for a proper seal and avoidance of overinflation. Nitrous oxide (N2O) is an inhalational anesthetic that is used with oxygen in the ratio 50:50 for the maintenance of anesthesia if there is no facility of medical air. However, N2O increases the intracuff pressure of the tracheal tube due to diffusion of N2O in to cuff during general anesthesia. The present research was done to study the cuff pressure changes during laparoscopic surgeries with N2O anesthesia and to assess its variation during the various stages of surgery and also its correlation with position of the patient. Materials and methods: A study was done in a tertiary-level hospital over a period of 1 year in 70 patients undergoing laparoscopic surgery. Endotracheal tube was inflated with incremental doses of 0.5 mL of air to a point where no leak on auscultation on the suprasternal area was noted. Cuff pressure measurement using cuff pressure monitor (Hand pressure gauge) was done at the time of first inflation of cuff up to 20–30 cm of H2O and airway pressure, along with total amount of air inflated was noted as “zero” reading. Thereafter, cuff pressure was measured at regular interval of 5 minutes. Cuff pressures and airway pressures were taken just prior to insufflation, 2 minutes after abdominal insufflation, thereafter every 15 minutes throughout surgery, and 2 minutes after desufflation and prior to extubation. Results: Out of 70 patients, maximum patients were of the age-group of 20–50 years (78.5%). There was no statistically significant difference between the groups. Cuff pressure at the induction was kept in range of 20–30 cm of H2O. In this study, mean tracheal cuff pressure at baseline was 21.10 + 6.16 (p value of 0.207) and prior to insufflation was 21 + 7.13 (p value of 0.733). The cuff pressures at 2 minutes post insufflation (P2), P15, P30, P45, and P60 were 31.40 ± 12.54 cm of H2O, 25.79 ± 8.68 cm of H2O, 24.61 ± 7.37 cm of H2O, 23.83 ± 9.43 cm of H2O, and 24.63 ± 4.77 cm of H2O, respectively. p value was strongly significant showing a positive correlation between pneumo-peritoneum and cuff pressures. We could see the cuff pressure continuously increasing in successive readings. Post desufflation and prior to extubation, there was a fall in cuff pressure with mean cuff pressure being 17.24 + 5.32 cm of H2O and 15.27 + 4.00 cm of H2O, respectively, which also suggests that cuff pressures increased with pneumoperitoneum. Conclusion: Use of N2O increases the cuff pressure (31.4 + 12.54 cm of H2O), especially immediately post-insufflation (35.54 + 12.06 cm of H2O), more so in head low position (36.28 + 12.13 cm of H2O). Mean airway pressure (Ppeak) also increased with pneumoperitoneum (22.60 + 4.38 cm of H2O). The regular monitoring of endotracheal tube cuff pressure should be a part of regular safe practice of anesthesia, and use of handy device like hand pressure gauge should be implemented in regular practice where N2O is used.


PDF Share
  1. Air leakage around endotracheal tube cuffs. Eur J Anaesthesiol 2004;21(6):448-453. DOI: 10.1097/00003643-200406000-00006.
  2. Is sealing cuff pressure, easy, reliable and safe technique for endotracheal tube cuff inflation?: a comparative study. Saudi J Anaesth 2011;5(2):185-189. DOI: 10.4103/1658-354X.82795.
  3. Endotracheal cuff pressure and tracheal mucosal blood flow: endoscopic study of effects of four large volume cuffs. Br Med J (Clin Res Ed) 1984;288(6422):965-968. DOI: 10.1136/bmj.288.6422.965 http://www.ncbi.nlm.nih.gov/pubmed/6423162. Accessed December 5, 2016.
  4. Impairment of tracheal mucosal blood flow by endotracheal tube cuffs and its recovery. A study on changes in blood flow and partial pressure of oxygen in tracheal mucosa. Osaka Daigaku Shigaku Zasshi 1986;31(2):334-350. http://www.ncbi.nlm.nih.gov/pubmed/3469384. Accessed December 5, 2016.
  5. Influence of pneumoperitoneum and patient positioning on respiratory system compliance. J Clin Anesth 2001;13(5):361-365. DOI: 10.1016/S0952-8180(01)00286-0 http://www.ncbi.nlm.nih.gov/pubmed/11498317. Accessed December 5, 2016.
  6. The impact of morbid obesity, pneumoperitoneum, and posture on respiratory system mechanics and oxygenation during laparoscopy. Anesth Analg 2002;94(5):1345-1350. DOI: 10.1097/00000539-200205000-00056 http://www.ncbi.nlm.nih.gov/pubmed/11973218. Accessed December 5, 2016.
  7. Alas, poor Trendelenburg and his position! A critique of its uses and effectiveness. Anesth Analg 1988;67(6):574-578. http://www.ncbi.nlm.nih.gov/pubmed/3288005. Accessed December 5, 2016.
  8. The physiologic effects of pneumoperitoneum in the morbidly obese. Ann Surg 2005;241(2):219-226. DOI: 10.1097/01.sla.0000151791.93571.70 http://www.ncbi.nlm.nih.gov/pubmed/15650630. Accessed December 5, 2016.
  9. Intracuff pressure and tracheal morbidity: influence of filling with saline during nitrous oxide anesthesia. Anesthesiology 2001;95(5):1120-1124. DOI: 10.1097/00000542-200111000-00015. http://www.ncbi.nlm.nih.gov/pubmed/11684980. Accessed December 5, 2016.
  10. Determinação de Volumes e Pressões de Balonetes de Tubos Traqueais Insuflados com Ar Ambiente ou Óxido Nitroso * Volume and Pressure of Tracheal Tube Cuffs Filled with Air or Nitrous Oxide.
  11. Nitrous oxide use and endotracheal tube rupture. Anesth Prog 1988;35(1):14-16. http://www.ncbi.nlm.nih.gov/pubmed/3422793. Accessed December 5, 2016.
  12. Tracheal tube cuff pressures. Anaesthesia 2007;40(5):444-447. DOI: 10.1111/j.1365-2044.1985.tb10846.x.
  13. Diffusion of nitrous oxide through endotracheal tube cuffs. Biomed Res 2016;27(1):40-45.
  14. Sore Throat After Endotracheal Intubation 1992. 897-900.
  15. Cuff pressure of endotracheal tubes after changes in body position in critically ill patients treated with mechanical ventilation. Am J Crit Care 2014;23(1):e1-e8. DOI: 10.4037/ajcc2014489.
  16. Endotracheal tube cuff pressure. ASA Abstr 2004;21(11):11-12. http://www.asaabstracts.com/strands/asaabstracts/abstract.htm;jsessionid=7EC17BCCB0E98687575CA8AD89EF33F8?year=2004&index=8&absnum=397.
  17. Endotracheal tube cuff pressures during general anesthesia while using air vs a 50% mixture of nitrous oxide and oxygen as inflating agents. Indian J Anaesthe 2007;51(1):24-27.
  18. Leakage of fluid around high-volume, low-pressure cuffs: a comparison of four tracheal tubes. Anaesthesia 2001;56(1):38-42. DOI: 10.1046/j.1365-2044.2001.01718.x.
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.