scholarly journals Comparison of endotracheal tube cuff inflation techniques by stethoscope and “just seal” method in patients undergoing surgeries under general anesthesia

2019 ◽  
Vol 5 (1) ◽  
pp. 16-21
Author(s):  
Mona Rajbhandari ◽  
Nagendra Bahadur KC ◽  
Bhuban Raj Kunwar ◽  
Bindu Laxmi Shah
Keyword(s):  
General Anesthesia ◽  
Endotracheal Tube ◽  
Sore Throat ◽  
Elective Surgery ◽  
Cuff Pressure ◽  
Thyroid Cartilage ◽  
Cuff Inflation ◽  
Endotracheal Tube Cuff ◽  
Tube Cuff ◽  
Tracheal Cuff

Background: Overinflation of the endotracheal tube cuff affects tracheal mucosa blood supply that causes postoperative complications like cough, sore throat and hoarseness. There is no standard cuff inflation technique that produces appropriate cuff pressure. The aim of this study was to find out better technique of cuff inflation that will produce adequate pressure with limited complication using stethoscope guided and “just seal”. Methods: This was prospective, randomized single blinded study of 100 American Society of Anesthesiologists Physical Status (ASA PS) I and II patients of 18-65 years undergoing elective surgery under general anesthesia requiring endotracheal intubation. Group J (n=50) received ‘just seal’ method of tracheal cuff inflation where air was introduced into cuff until audible leak at mouth disappeared and Group S (n=50) received stethoscope-guided tracheal cuff inflation where air was introduced into cuff until harsh breath sound changed to soft while listening with stethoscope bell over the thyroid cartilage. Volume of air in endotracheal tube cuff, cuff pressure following inflation and post-operative sore throat, hoarseness and cough at 24 hour were assessed. Results: Demographic details, mean volume of air in cuff, mean cuff pressure and incidence of postoperative adverse effects like sore throat, hoarseness and cough at 24 hours between the groups were comparable. Conclusion: Both the stethoscope guided and “just seal” cuff inflation techniques were equally effective in producing adequate cuff pressure of 20-30 cmH2O with limited complication.

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

2020 ◽  
Vol 3 (2) ◽  
pp. 46-49
Author(s):  
Hunsehalli Revanasiddappa Narendra ◽  
Aparna Nerurkar ◽  
Shibu Sasidharan
Keyword(s):  
Laparoscopic Surgery ◽  
General Anesthesia ◽  
Endotracheal Tube ◽  
Airway Pressure ◽  
Cuff Pressure ◽  
Pressure Gauge ◽  
Endotracheal Tube Cuff ◽  
Tube Cuff ◽  
Observational Analysis ◽  
Endotracheal Tube Cuff Pressure

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. How to cite this article Narendra HR, Nerurkar A, Sasidharan S. Observational Analysis of Changes in Endotracheal Tube Cuff Pressure During Laparoscopic Surgery. J Med Acad 2020;3(2):46–49.

scholarly journals Evaluation of Endotracheal Tube Cuff Pressure in Laparoscopic Cholecystectomy and Postoperative Sore Throat

2018 ◽  
Vol 15 (3) ◽  
pp. 282-285 ◽  
Author(s):  
Gajal Lakhe ◽  
Surendra Mohan Sharma
Keyword(s):  
Nitrous Oxide ◽  
Laparoscopic Cholecystectomy ◽  
Endotracheal Tube ◽  
Sore Throat ◽  
Cuff Pressure ◽  
Study Group ◽  
Endotracheal Tube Cuff ◽  
Postoperative Sore Throat ◽  
Tube Cuff ◽  
Endotracheal Tube Cuff Pressure

Background: The use of nitrous oxide and carboperitoneum in laparoscopic cholecystectomy lead to increase in endotracheal tube cuff pressure. It may impair tracheal mucosal perfusion with subsequent tracheal damage. The purpose of this study was to evaluate cuff pressure and incidence of post-operative sore throat in patients undergoing laparoscopic cholecystectomy.Methods: In this prospective observational study, 128 patients aged 18-65 years of American Society of Anesthesiologist physical status I and II undergoing laparoscopic cholecystectomy were enrolled and allocated alternately into two groups, Study Group (Maintenance of anesthesia with sevoflurane 1-2%, oxygen/nitrous oxide mixture; 40/60), Control Group (Maintenance of anesthesia with sevoflurane 1-2%, oxygen/air mixture; 40/60) were analysed and comapared. Each group contained 64 patients. Aneroid manometer was used to monitor cuff pressure. Volume of air used to inflate the cuff, baseline cuff pressure, comparison of intraoperative cuff pressure and incidence of postoperative sore throat were measured.Results: The study results demonstrated higher cuff pressure in study group at all times after the creation of carboperitoneum (p=0.00) with increased incidence of sore throat(p=0.004).Conclusions: Increase in endotracheal tube cuff pressure was noted with the use of nitrous oxide in laparoscopic cholecystectomy with subsequent post-operative airway complication. Monitoring of cuff pressure is simple, noninvasive and efficient way of achieving therapeutic cuff pressure of 20-30 cm of H2O and thus recommends its use. 

scholarly journals Is sealing cuff pressure, easy, reliable and safe technique for endotracheal tube cuff inflation?: A comparative study

2011 ◽  
Vol 5 (2) ◽  
pp. 185 ◽  
Author(s):  
RoshdiR Al-metwalli ◽  
HanyA Mowafi ◽  
Mohammed Abdulshafi ◽  
AbdulmohsenA Al-Ghamdi ◽  
Sayed Sadek ◽  
...  
Keyword(s):  
Comparative Study ◽  
Endotracheal Tube ◽  
Cuff Pressure ◽  
Cuff Inflation ◽  
Endotracheal Tube Cuff ◽  
Tube Cuff ◽  
Safe Technique
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