Araştırma Makalesi
BibTex RIS Kaynak Göster

Effects of different endotracheal tube cuff pressures on dysphagia after anterior cervical spine surgery

Yıl 2022, Cilt: 47 Sayı: 2, 614 - 621, 30.06.2022
https://doi.org/10.17826/cumj.1049742

Öz

of two different endotracheal cuff pressures on postoperative dysphagia, sore throat, dysphonia, and hospital stay in anterior cervical spine surgery.
Materials and Methods: Seventy patients scheduled for surgery were randomly divided into two groups. After intubation, the endotracheal cuff pressure was inflated to 20 cmH2O and 25 cmH2O in Group I (n=35) and Group II (n=35), respectively. The degree of dysphagia was assessed with the Bazaz dysphagia score. The sore throat was evaluated via Visual Analog Scale. Total pain score regarding the operation site was evaluated using VAS. Hoarseness was evaluated based on the presence of any changes to the voice asharsh or strained. Dysphagia, dysphonia, and sore throat were assessed on the post-surgical 1st and 24th hours.
Results: No differences in demographic data were present between the groups. Dysphagia and sore throat at the post-surgical 1st and 24th hours were significantly lesser in Group I than in Group II. The frequency of dysphonia was significantly less in Group I than compared to Group II only at the post-surgical 1st hour. No differences in VAS scores at the post-surgical 1st and 24th hours were present between the groups.
Conclusion: In this study, it was shown that the risk of developing dysphagia after surgery was significantly reduced with 20 cmH2O endotracheal cuff pressure compared to 25 cmH2O. Also, lower cuff pressure was associated with a milder sore throat, less hoarseness at 1 hour postoperatively, and a shorter hospital stay.

Kaynakça

  • 1. Anderson KK, Arnold PM. Oropharyngeal Dysphagia after anterior cervical spine surgery: a review. Global spine journal. 2013;3:273-286.doi: 10.1055/s-0033-1354253.
  • 2. Campbell PG, Yadla S, Malone J, Zussman B, Maltenfort MG, Sharan AD, et al. Early complications related to approach in cervical spine surgery: single-center prospective study. World neurosurgery. 2010;74:363-368.doi: 10.1016/j.wneu.2010.05.034.
  • 3. Ratnaraj J, Todorov A, McHugh T, Cheng MA, Lauryssen C. Effects of decreasing endotracheal tube cuff pressures during neck retraction for anterior cervical spine surgery. Journal of neurosurgery. 2002;97:176-179.doi: 10.3171/spi.2002.97.2.0176.
  • 4. Efrati S, Bolotin G, Levi L, Zaaroor M, Guralnik L, Weskler N, et al. Optimization of Endotracheal Tube Cuff Pressure by Monitoring CO2 Levels in the Subglottic Space in Mechanically Ventilated Patients: A Randomized Controlled Trial. Anesthesia & Analgesia. 2017;125:1309-1315.doi: 10.1213/ANE.0000000000002358.
  • 5. Duarte NMDC, Caetano AMM, Arouca GO, Ferrreira AT, Figueiredo JL. Subjective method for tracheal tube cuff inflation: performance of anesthesiology residents and staff anesthesiologists. Prospective observational study. Brazilian journal of anesthesiology. 2020;70:9-14. doi: 10.1016/j.bjan.2019.09.010.
  • 6. Hockey CA, van Zundert AAJ, Paratz JD. Does objective measurement of tracheal tube cuff pressures minimise adverse effects and maintain accurate cuff pressures? A systematic review and meta-analysis. Anaesthesiaandintensive care. 2016;44:560-570.doi: 10.1177/0310057X1604400503.
  • 7. Garg R, Rath GP, Bithal PK, Prabhakar H, Marda MK. Effects of retractor application on cuff pressure and vocal cord function in patients undergoing anterior cervical discectomy and fusion. Indian journal of anaesthesiology. 2010;54:292-295.doi: 10.4103/0019-5049.68370.
  • 8. Bazaz R, Lee MJ, Yoo JU. Incidence of dysphagia after anterior cervical spine surgery: a prospective study. Spine (Phila Pa 1976). 2002;27:2453-2458.doi: 10.1097/00007632-200211150-00007.
  • 9. Frempong-Boadu A, Houten JK, Osborn B, Opulencia J, Kells L, Guida DD, et al. Swallowing and speech dysfunction in patients undergoing anterior cervical discectomy and fusion: a prospective, objective preoperative and postoperative assessment. Journal of spinal disorders and techniques. 2002;15:362-368.doi: 10.1097/00024720-200210000-00004.
  • 10. Riley 3rd LH, Vaccaro AR, Dettori JR, Hashimoto R. Postoperative dysphagia in anterior cervical spine surgery. Spine. 2010;35:76-85.doi: 10.1097/BRS.0b013e3181d81a96.
  • 11. Fisahn C, Yilmaz E, Iwanaga J, Schmidt C, Benca E, Chapman JR, et al. Avoiding the Esophageal Branches of the Recurrent Laryngeal Nerve During Retractor Placement: Precluding Postoperative Dysphagia During Anterior Approaches to the Cervical Spine. Global spine journal. 2019;9:383-387.doi: 10.1177/2192568218810198.
  • 12. Smith-Hammond CA, New KC, Pietrobon R, Curtis DJ, Scharver CH, Turner DA. Prospective analysis of incidence and risk factors of dysphagia in spine surgery patients: comparison of anterior cervical, posterior cervical, and lumbar procedures. Spine (Phila Pa 1976). 2004;29:1441-1446.doi: 10.1097/01.brs.0000129100.59913.ea.
  • 13. Liu J, Hai Y, Kang N, Chen X, Zhang Y. Risk factors and preventative measures of early and persistent dysphagia after anterior cervical spine surgery: a systematic review. European spine journal. 2018 ;27:1209-1218. doi: 10.1007/s00586-017-5311-4.
  • 14. Joaquim AF, Murar J, Savage JW, Patel AA. Dysphagia after anterior cervical spine surgery: a systematic review of potential preventative measures. The spine journal. 2014 ;14:2246-2260. doi: 10.1016/j.spinee.2014.03.030.
  • 15. Gowd AK, Vahidi NA, Magdycz WP, Zollinger PL, Carmouche JJ. Correlation of Voice Hoarseness and Vocal Cord Palsy: A Prospective Assessment of Recurrent Laryngeal Nerve Injury Following Anterior Cervical Discectomy and Fusion. International journal of spine surgery. 2021;15:12-17. doi: 10.14444/8001.
  • 16. Grasso G, Leone L, Torregrossa F. Dysphagia Prevention in Anterior Cervical Discectomy Surgery: Results from a Prospective Clinical Study. World neurosurgery. 2019;125:1176-1182. doi: 10.1016/j.wneu.2019.01.273.
  • 17. Kowalczyk I, Ryu WH, Rabin D, Arango M, Duggal N. Reduced Endotracheal Tube Cuff Pressure to Assess Dysphagia After Anterior Cervical Spine Surgery. Journal of spinal disorders and techniques. 2015;28:552-8.doi: 10.1097/BSD.0000000000000033.
  • 18. In 't Veld BA, Rettig TCD, de Heij N, de Vries J, Wolfs JFC, Arts MP. Maintaining endotracheal tube cuff pressure at 20 mmHg during anterior cervical spine surgery to prevent dysphagia: a double-blind randomized controlled trial. European spine journal. 2019;28:353-361. doi: 10.1007/s00586-018-5798-3.
  • 19. Ünsal Ö, Seyhun N, Türk B, Ekici M, Dobrucalı H, Turgut S. The Evaluation of Upper Airway Complications Secondary to Intubation: Cuff Pressure Manometer Versus Conventional Palpation Method. The medical bulletin of sislietfal hospital. 2018;52:289-295. doi: 10.5350/SEMB.20171214085933.
  • 20. Inada T, Kawachi S, Kuroda M. Tracheal tube cuff pressure during cardiac surgery using cardiopulmonary bypass. British journal ofanaesthesia. 1995;74(3):283-6.doi: 10.1093/bja/74.3.283.
  • 21. Koo CH, Sohn HM, Choi ES, Choi JY, Oh AY, Jeon YT, Ryu JH. The Effect of Adjustment of Endotracheal Tube Cuff Pressure during Scarless Remote Access Endoscopic and Robotic Thyroidectomy on Laryngo-Pharyngeal Complications: Prospective Randomized and Controlled Trial. Journal of clinical medicine. 2019;8:1787. doi: 10.3390/jcm8111787.
  • 22. Kim D, Jeon B, Son JS, Lee JR, Ko S, Lim H. The changes of endotracheal tube cuff pressure by the position changes from supine to prone and the flexion and extension of head. Korean journal ofanesthesiolology. 2015;68:27-31.doi: 10.4097/kjae.2015.68.1.27.
  • 23. Riley LH 3rd, Skolasky RL, Albert TJ, Vaccaro AR, Heller JG. Dysphagia after anterior cervical decompression and fusion: prevalence and risk factors from a longitudinal cohort study. Spine (Phila Pa 1976). 2005;30:2564-2569. doi: 10.1097/01.brs.0000186317.86379.02.
  • 24. Jellish WS, Jensen RL, Anderson DE, Shea JF. Intraoperative electromyographic assessment of recurrent laryngeal nerve stress and pharyngeal injury during anterior cervical spine surgery with Caspar instrumentation. Journal of neurosurgery. 1999;91:170-174.doi: 10.3171/spi.1999.91.2.0170.
  • 25. Rihn JA, Kane J, Albert TJ, Vaccaro AR, Hilibrand AS. What is the incidence and severity of dysphagia after anterior cervical surgery? Clinicalorthopaedics and related research. 2011;469:658-665.doi: 10.1007/s11999-010-1731-8.

Anterior servikal omurga cerrahisi sonrası farklı endotrakeal tüp kaf basınçlarının disfajı üzerine etkileri

Yıl 2022, Cilt: 47 Sayı: 2, 614 - 621, 30.06.2022
https://doi.org/10.17826/cumj.1049742

Öz

Amaç: Bu çalışmada, anterior servikal omurga cerrahisinde iki farklı endotrakeal kaf basıncının postoperatif disfaji, boğaz ağrısı, disfoni ve hastanede kalış üzerindeki etkilerinin karşılaştırılması amaçlanmıştır.
Gereç ve Yöntem: Cerrahi planlanan 70 hasta rastgele iki gruba ayrıldı. Entübasyondan sonra endotrakeal kaf basıncı Grup I'de (n=35) ve Grup II'de (n=35) sırasıyla 20 cmH2O ve 25 cmH2O'ya şişirildi. Disfajinin derecesi Bazaz disfaji skoru ile değerlendirildi. Boğaz ağrısı Görsel Analog Skala ile değerlendirildi. Operasyon bölgesine ilişkin toplam ağrı skoru VAS kullanılarak değerlendirildi (. Ses kısıklığı, seste herhangi bir değişiklik olup olmamasına göre sert veya gergin olarak değerlendirildi. Disfaji, disfoni ve boğaz ağrısı ameliyat sonrası 1. ve 24. saatlerde değerlendirildi.
Bulgular: Gruplar arasında demografik verilerde farklılık yoktu. Ameliyat sonrası 1. ve 24. saatlerde yutma güçlüğü ve boğaz ağrısı Grup I'de Grup II'ye göre anlamlı olarak daha azdı. Disfoni sıklığı Grup I'de Grup II'ye kıyasla sadece cerrahi sonrası 1. saatte anlamlı olarak daha azdı. Gruplar arasında ameliyat sonrası 1. ve 24. saatlerde VAS skorlarında fark yoktu.
Sonuç: Bu çalışmada, 25 cmH2O'ya kıyasla endotrakeal kaf basıncı 20 cmH2O ile cerrahi sonrası disfaji gelişme riskinin önemli ölçüde azalttığı gösterilmiştir. Ayrıca, daha düşük kaf basıncı, daha hafif bir boğaz ağrısı, ameliyat sonrası 1. saatte daha az ses kısıklığı ve daha kısa hastanede kalış süresi ile ilişkilendirildi.

Kaynakça

  • 1. Anderson KK, Arnold PM. Oropharyngeal Dysphagia after anterior cervical spine surgery: a review. Global spine journal. 2013;3:273-286.doi: 10.1055/s-0033-1354253.
  • 2. Campbell PG, Yadla S, Malone J, Zussman B, Maltenfort MG, Sharan AD, et al. Early complications related to approach in cervical spine surgery: single-center prospective study. World neurosurgery. 2010;74:363-368.doi: 10.1016/j.wneu.2010.05.034.
  • 3. Ratnaraj J, Todorov A, McHugh T, Cheng MA, Lauryssen C. Effects of decreasing endotracheal tube cuff pressures during neck retraction for anterior cervical spine surgery. Journal of neurosurgery. 2002;97:176-179.doi: 10.3171/spi.2002.97.2.0176.
  • 4. Efrati S, Bolotin G, Levi L, Zaaroor M, Guralnik L, Weskler N, et al. Optimization of Endotracheal Tube Cuff Pressure by Monitoring CO2 Levels in the Subglottic Space in Mechanically Ventilated Patients: A Randomized Controlled Trial. Anesthesia & Analgesia. 2017;125:1309-1315.doi: 10.1213/ANE.0000000000002358.
  • 5. Duarte NMDC, Caetano AMM, Arouca GO, Ferrreira AT, Figueiredo JL. Subjective method for tracheal tube cuff inflation: performance of anesthesiology residents and staff anesthesiologists. Prospective observational study. Brazilian journal of anesthesiology. 2020;70:9-14. doi: 10.1016/j.bjan.2019.09.010.
  • 6. Hockey CA, van Zundert AAJ, Paratz JD. Does objective measurement of tracheal tube cuff pressures minimise adverse effects and maintain accurate cuff pressures? A systematic review and meta-analysis. Anaesthesiaandintensive care. 2016;44:560-570.doi: 10.1177/0310057X1604400503.
  • 7. Garg R, Rath GP, Bithal PK, Prabhakar H, Marda MK. Effects of retractor application on cuff pressure and vocal cord function in patients undergoing anterior cervical discectomy and fusion. Indian journal of anaesthesiology. 2010;54:292-295.doi: 10.4103/0019-5049.68370.
  • 8. Bazaz R, Lee MJ, Yoo JU. Incidence of dysphagia after anterior cervical spine surgery: a prospective study. Spine (Phila Pa 1976). 2002;27:2453-2458.doi: 10.1097/00007632-200211150-00007.
  • 9. Frempong-Boadu A, Houten JK, Osborn B, Opulencia J, Kells L, Guida DD, et al. Swallowing and speech dysfunction in patients undergoing anterior cervical discectomy and fusion: a prospective, objective preoperative and postoperative assessment. Journal of spinal disorders and techniques. 2002;15:362-368.doi: 10.1097/00024720-200210000-00004.
  • 10. Riley 3rd LH, Vaccaro AR, Dettori JR, Hashimoto R. Postoperative dysphagia in anterior cervical spine surgery. Spine. 2010;35:76-85.doi: 10.1097/BRS.0b013e3181d81a96.
  • 11. Fisahn C, Yilmaz E, Iwanaga J, Schmidt C, Benca E, Chapman JR, et al. Avoiding the Esophageal Branches of the Recurrent Laryngeal Nerve During Retractor Placement: Precluding Postoperative Dysphagia During Anterior Approaches to the Cervical Spine. Global spine journal. 2019;9:383-387.doi: 10.1177/2192568218810198.
  • 12. Smith-Hammond CA, New KC, Pietrobon R, Curtis DJ, Scharver CH, Turner DA. Prospective analysis of incidence and risk factors of dysphagia in spine surgery patients: comparison of anterior cervical, posterior cervical, and lumbar procedures. Spine (Phila Pa 1976). 2004;29:1441-1446.doi: 10.1097/01.brs.0000129100.59913.ea.
  • 13. Liu J, Hai Y, Kang N, Chen X, Zhang Y. Risk factors and preventative measures of early and persistent dysphagia after anterior cervical spine surgery: a systematic review. European spine journal. 2018 ;27:1209-1218. doi: 10.1007/s00586-017-5311-4.
  • 14. Joaquim AF, Murar J, Savage JW, Patel AA. Dysphagia after anterior cervical spine surgery: a systematic review of potential preventative measures. The spine journal. 2014 ;14:2246-2260. doi: 10.1016/j.spinee.2014.03.030.
  • 15. Gowd AK, Vahidi NA, Magdycz WP, Zollinger PL, Carmouche JJ. Correlation of Voice Hoarseness and Vocal Cord Palsy: A Prospective Assessment of Recurrent Laryngeal Nerve Injury Following Anterior Cervical Discectomy and Fusion. International journal of spine surgery. 2021;15:12-17. doi: 10.14444/8001.
  • 16. Grasso G, Leone L, Torregrossa F. Dysphagia Prevention in Anterior Cervical Discectomy Surgery: Results from a Prospective Clinical Study. World neurosurgery. 2019;125:1176-1182. doi: 10.1016/j.wneu.2019.01.273.
  • 17. Kowalczyk I, Ryu WH, Rabin D, Arango M, Duggal N. Reduced Endotracheal Tube Cuff Pressure to Assess Dysphagia After Anterior Cervical Spine Surgery. Journal of spinal disorders and techniques. 2015;28:552-8.doi: 10.1097/BSD.0000000000000033.
  • 18. In 't Veld BA, Rettig TCD, de Heij N, de Vries J, Wolfs JFC, Arts MP. Maintaining endotracheal tube cuff pressure at 20 mmHg during anterior cervical spine surgery to prevent dysphagia: a double-blind randomized controlled trial. European spine journal. 2019;28:353-361. doi: 10.1007/s00586-018-5798-3.
  • 19. Ünsal Ö, Seyhun N, Türk B, Ekici M, Dobrucalı H, Turgut S. The Evaluation of Upper Airway Complications Secondary to Intubation: Cuff Pressure Manometer Versus Conventional Palpation Method. The medical bulletin of sislietfal hospital. 2018;52:289-295. doi: 10.5350/SEMB.20171214085933.
  • 20. Inada T, Kawachi S, Kuroda M. Tracheal tube cuff pressure during cardiac surgery using cardiopulmonary bypass. British journal ofanaesthesia. 1995;74(3):283-6.doi: 10.1093/bja/74.3.283.
  • 21. Koo CH, Sohn HM, Choi ES, Choi JY, Oh AY, Jeon YT, Ryu JH. The Effect of Adjustment of Endotracheal Tube Cuff Pressure during Scarless Remote Access Endoscopic and Robotic Thyroidectomy on Laryngo-Pharyngeal Complications: Prospective Randomized and Controlled Trial. Journal of clinical medicine. 2019;8:1787. doi: 10.3390/jcm8111787.
  • 22. Kim D, Jeon B, Son JS, Lee JR, Ko S, Lim H. The changes of endotracheal tube cuff pressure by the position changes from supine to prone and the flexion and extension of head. Korean journal ofanesthesiolology. 2015;68:27-31.doi: 10.4097/kjae.2015.68.1.27.
  • 23. Riley LH 3rd, Skolasky RL, Albert TJ, Vaccaro AR, Heller JG. Dysphagia after anterior cervical decompression and fusion: prevalence and risk factors from a longitudinal cohort study. Spine (Phila Pa 1976). 2005;30:2564-2569. doi: 10.1097/01.brs.0000186317.86379.02.
  • 24. Jellish WS, Jensen RL, Anderson DE, Shea JF. Intraoperative electromyographic assessment of recurrent laryngeal nerve stress and pharyngeal injury during anterior cervical spine surgery with Caspar instrumentation. Journal of neurosurgery. 1999;91:170-174.doi: 10.3171/spi.1999.91.2.0170.
  • 25. Rihn JA, Kane J, Albert TJ, Vaccaro AR, Hilibrand AS. What is the incidence and severity of dysphagia after anterior cervical surgery? Clinicalorthopaedics and related research. 2011;469:658-665.doi: 10.1007/s11999-010-1731-8.
Toplam 25 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Klinik Tıp Bilimleri
Bölüm Araştırma
Yazarlar

Sedef Gülçin Ural 0000-0002-4136-4623

İbrahim Hakkı Tör 0000-0003-0246-3220

Yayımlanma Tarihi 30 Haziran 2022
Kabul Tarihi 31 Mart 2022
Yayımlandığı Sayı Yıl 2022 Cilt: 47 Sayı: 2

Kaynak Göster

MLA Ural, Sedef Gülçin ve İbrahim Hakkı Tör. “Effects of Different Endotracheal Tube Cuff Pressures on Dysphagia After Anterior Cervical Spine Surgery”. Cukurova Medical Journal, c. 47, sy. 2, 2022, ss. 614-21, doi:10.17826/cumj.1049742.