Comparison of endotracheal tube cuff pressures inflated with saline or air in gynecological laparoscopic surgery

Year 2021, Volume: 34 Issue: 2, 140 - 146, 31.05.2021

Selin Sahın Ahmet Besir Ali Akdogan Ersagun Tugcugıl Sedat Saylan

https://doi.org/10.5472/marumj.942649

Abstract

Objective: We compared the air or saline insufflated endotracheal tube (ETT) cuff pressures and their effects on postoperative
respiratory complications in gynecological laparoscopic surgeries in the Trendelenburg position (TP).
Patients and Methods: This prospective study was carried out on a total of 60 patients, whose ages ranged from 18 to 65 years and
who were classified by the American Society of Anesthesiologists (ASA) as I-III. They were scheduled for gynecological laparoscopic
surgery in TP. Patients included in the study were randomly divided into two groups as the saline (Group S, n=30) and air (Group A,
n=30) groups. ETT cuff pressures and peak airway pressures were recorded immediately after intubation and at 10-minute intervals
during the intraoperative period.
Results: The cuff pressure and maximum cuff pressure values in the saline group were significantly lower than in the air group in
the 50-minute (p<0.05). The sore throat and analgesic consumption were significantly lower in Group S in postoperative 24 hours
(p<0.001, for all).
Conclusion: The intraoperative cuff pressures, postoperative sore throat, and analgesic consumption were lower in the salineinsufflated
group than in the air-insufflated group in gynecological laparoscopic surgery in TP.

Keywords

Laparoscopic surgery, Trendelenburg position, Sore throat, Cuff pressure.

References

• Morgan GE, Mikhail MS, Murray MJ, editors. Clinical Anesthesiology 5th ed.International Edition: New York: Lange Medical Books, 2015:309-41.
• Atlas GM. A mathematical model of differential tracheal tube cuff pressure: effects of diffusion and temperature. J Clin Monit Comput 2005;19:415-25. doi: 10.1007/s10877.005.1626-5.
• Girling KJ, Bedforth NM, Spendlove JL, Mahajan RP. Assessing neuromuscular block at the larynx: the effect of change in resting cuff pressure and a comparison with video imaging in anesthetized humans. Anesth Analg 1999;88:426- 31. doi: 10.1097/00000.539.199902000-00038.
• Godoy AC, Vieira RJ, Capitani EM. Endotracheal tube cuff pressure alteration after changes in position in patients under mechanical ventilation. J Bras Pneumol 2008;34:294-97. doi: 10.1590/s1806.371.3200800.050.0008.
• Hameed AA, Mohamed H, Al-Mansoori M. Acquired tracheoesophageal fistula due to high intracuff pressure. Ann Thorac Med 2008;3:23-5. doi: 10.4103/1817-1737.37950.
• Harris R, Joseph A. Acute tracheal rupture related to endotracheal intubation: case report. J Emerg Med 2000;18:35- 9. doi: 10.1016/s0736-4679(99)00159-6.
• Pookamala S, Thakar A, Puri K, Singh P, Kumar R, Sharma SC. Acquired subglottic stenosis: aetiological profile and treatment results. J Laryngol Otol 2014;128:641-8. doi: 10.1017/S002.221.5114000966.
• Touat L, Fournier C, Ramon P, Salleron J, Durocher A, Nseir S. Intubation-related tracheal ischemic lesions: incidence, risk factors, and outcome. Intensive Care Med 2013;39:575-82. doi: 10.1007/s00134.012.2750-6.
• Rosero EB, Ozayar E, Eslava-Schmalbach J, Minhajuddin A, Joshi GP. Effects of increasing airway pressures on the pressure of the endotracheal tube cuff during pelvic laparoscopic surgery. Anesth Analg 2018;127:120-5. doi: 10.1213/ ANE.000.000.0000002657.
• American Thoracic Society, Infectious Diseases Society of America. Guidelines for the management of adults with hospital – acquired, ventilator-associated, and healthcareassociated pneumonia. Am J Respir Crit Care Med 2005;171:388-416. doi: 10.1164/rccm.200405-644ST.
• Bernhard WN, Yost L, Joynes D, Cothalis S, Turndorf H. Intracuff pressures in endotracheal and tracheostomy tubes. Related cuff physical characteristics. Chest 1985;87:720-5. doi: 10.1378/chest.87.6.720.
• Diaz E, Rodríguez AH, Rello J. Ventilator-associated pneumonia: issues related to the artificial airway. Respir Care 2005;50:900-6.
• Nordin U. The trachea and cuff-induced tracheal injury. An experimental study on causative factors and prevention. Acta Otolaryngol Suppl 1977;345:1-71.
• Seegobin RD, van Hasselt GL. Endotracheal cuff pressure and tracheal mucosal blood flow: endoscopic study of effects of four large volume cuffs. Br Med J (Clin Res Ed). 1984;288:965- 8. doi: 10.1136/bmj.288.6422.965.
• Geng G, Hu J, Huang S. The effect of endotracheal tube cuff pressure change during gynecological laparoscopic surgery on postoperative sore throat: a control study. Journal of Clin Monit Comput 2015;29:141-4. doi: 10.1007/s10877.014.9578- 2.
• Wu CY, Yeh YC, Wang MC, Lai CH, Fan SZ. Changes in endotracheal tube cuff pressure during laparoscopic surgery in head-up or head-down position. BMC Anesthesiology 2014 31;14:75. eCollection 2014. doi: 10.1186/1471-2253-14-75.
• Farhang, B, Grondin, L. The effect of zinc lozenge on postoperative sore throat: a prospective randomized, doubleblinded, placebo-controlled study. Anesthesia & Analgesia 2018; 126:78-83. doi: 10.1213/ANE.000.000.0000002494.
• Kuriyama, A, Maeda, H, Sun, R, Aga, M. Topical application of corticosteroids to tracheal tubes to prevent postoperative sore throat in adults undergoing tracheal intubation: a systematic review and meta‐analysis. Anaesthesia 2018;73:1546-56. doi: 10.1111/anae.14273.
• Sanaie S, Rahmani F, Chokhachian S, et al. Comparison of tracheal tube cuf pressure with two technique: fxed volume and minimal leak test techniques. J Cardiovasc Thorac Res. 2019;11:48–52. doi: 10.15171/jcvtr.2019.08.
• Aldrete JA. Post-anesthesia recovery score revisited. J Clin Anesth 1995;7:89-91. doi: 10.1016/0952-8180(94)00001-K
• Mol DA, De Villers Gdu T, Claassen AJ, Joubert G. Use and care of an endotracheal/tracheostomy tube cuff-are intensive care unit staff adequately informed? S Afr J Surg 2004;42:14-6.
• Liu J, Zhang X, Gong W et al. Correlations between controlled endotracheal tube cuff pressure and postprocedural complications: A multicenter study. Anesth Analg 2010;111:1133-7. doi: 10.1213/ANE.0b013e3181f2ecc7.
• Rello, J, Sonora, R, Jubert, P, Artigas, A, Rué, M, Vallés, J. Pneumonia in intubated patients: role of respiratory airway care. Am J Respir Crit Care Med 1996;154:111-5. doi: 10.1164/ ajrccm.154.1.8680665.
• Jaensson M, Gupta A, Nilsson UG. Gender differences in risk factors for airway symptoms following tracheal intubation. Acta Anaesthesiol Scand 2012;56:1306-13. doi: 10.1111/j.1399- 6576.2012.02771.x.
• Cakmakkaya, O. S, Kaya, G, Altintas, F, Hayirlioglu, M, Ekici, B. Restoration of pulmonary compliance after laparoscopic surgery using a simple alveolar recruitment maneuver. J Clin Anesth 2009;21:422-6. doi: 10.1016/j.jclinane.2009.08.001.
• Yildirim Z B, Uzunkoy A, Cigdem A, Ganidagli S, Ozgonul A. Changes in cuff pressure of endotracheal tube during laparoscopic and open abdominal surgery. Surg Endosc 2012; 26:398-401. doi: 10.1007/s00464.011.1886-8.
• Gerges FJ, Kanazi GE, Jabbour-Khoury SI. Anesthesia for laparoscopy: a review. J Clin Anesth 2006;18:67-78. doi: 10.1016/j.jclinane.2005.01.013.
• Kwon Y, Jang J S, Hwang S M, et al. The change of endotracheal tube cuff pressure during laparoscopic surgery. Open Medicine 2019;14:431-6. doi: 10.1515/med-2019-0046.
• Estebe JP, Delahaye S, Le Corre P, et al. Alkalinization of intra-cuff lidocaine and use of gel lubrication protect against tracheal tube-induced emergence phenomena. Br J Anaesth 2004;92:361-6. doi: 10.1093/bja/aeh078.
• Chang J E, Kim H, Han S H, Lee J M, Ji S, Hwang J Y. Effect of endotracheal tube cuff shape on postoperative sore throat after endotracheal intubation. Anesthesia & Analgesia 2017; 125:1240-5. doi: 10.1213/ANE.000.000.0000001933.
• Canbay O, Celebi N, Sahin A, Celiker V, Ozgen S, Aypar U. Ketamine gargle for attenuating postoperative sore throat. Br J Anaesth 2008;100:490-3. doi: 10.1093/bja/aen023.
• Halliday D, Resnick R, Walker J. Fundamentals of physics. New York, NY, Wiley, 2001.
• Ahmad N L, Norsidah A M. Change in endotracheal tube cuff pressure during nitrous oxide anaesthesia: A comparison between air and distilled water cuff inflation Anaesthesia and Intensive Care 2001;29:510-4. doi: 10.1177/0310057X010.290.0511.
• Beşir A, Erdoğan G. Comparison between cuff pressures of endotracheal tubes inflated with saline or air in low-flow anesthesia. Clin Exp Health Sci 2018; 8:112-7. doi:10.5152/ clinexphealthsci.2017.537.
• Shroff PP, Patil V. Efficacy of cuff inflation media to prevent postintubation-related emergence phenomenon: air, saline and alkalinized lignocaine. Eur J Anaesthesiol 2009;26:458- 62. doi: 10.1097/eja.0b013e32832403fa.
• Kumar S P, Ravikumar A. Biometric study of the internal dimensions of subglottis and upper trachea in adult Indian population. Indian Journal of Otolaryngol Head Neck Surg 2014;66:261-6. doi: 10.1007/s12070.012.0477-x.