A Comparative Study of 2 Agents, Air and Distilled Water for Inflation of the Cuffs of Endotracheal Tubes During Laparoscopic Surgical Procedures Under General Anaesthesia (original) (raw)
Related papers
Changes in cuff pressure of endotracheal tube during laparoscopic and open abdominal surgery
Surgical Endoscopy, 2012
Background The purpose of this study was to investigate endotracheal tube cuff pressure alteration in patients during laparoscopic cholecystectomy surgery. Methods Forty patients with ASA I-II physical status, who were scheduled for elective laparoscopic (group I) or open abdominal surgery (group II) were enrolled in the study. Tracheal intubation was always performed by an experienced anesthesiologist. The endotracheal tube cuff was inflated with air through a 10-ml syringe. The cuff was connected to a manometer. The endotracheal cuff pressure was registered every 5 min after tracheal intubation. At the time of discharge from the Post-Anesthesia Care Unit (PACU) and 12 h after tracheal extubation, patients were asked about their laryngotracheal condition by an independent observer who was uninformed of the patient allocation groups. We investigated laryngotracheal complaints such as sore throat, dysphasia, and hoarseness. Results The endotracheal cuff pressures in group I were significantly higher than those in the group II at all time points studied (P \ 0.05). The endotracheal cuff pressures exceeded the critical pressure of 30 cmH 2 O after 5 min in the group I (intra-abdominal pneumoperitoneum was started). The incidence of sore throat was higher in group I than in group II in the PACU and at 12 h. Conclusion This study indicates that the CO 2 pneumoperitoneum and Trendelenburg position used during laparoscopy increase endotracheal cuff pressure and lead to discomfort in the postoperative patient. Measurement of endotracheal cuff pressure is a simple and inexpensive procedure and should be applied in patients under going laparoscopic surgery.
Sao Paulo Medical Journal, 2007
CONTEXT AND OBJECTIVE: High intracuff pressure in endotracheal tubes (ETs) may cause tracheal lesions. The aim of this study was to evaluate the effectiveness and safety of endotracheal tube cuffs filled with air or with alkalinized lidocaine. DESIGN AND SETTING: This was a prospective clinical study at the Department of Anesthesiology, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista. METHODS: Among 50 patients, ET cuff pressures were recorded before, 30, 60, 90 and 120 minutes after starting and upon ending nitrous oxide anesthesia. The patients were randomly allocated to two groups: Air, with ET cuff inflated with air to attain a cuff pressure of 20 cmH2O; and Lido, with ET cuff filled with 2% lidocaine plus 8.4% sodium bicarbonate to attain the same pressure. ET discomfort before tracheal extubation, and sore throat, hoarseness and coughing incidence were studied at the time of discharge from the post-anesthesia care unit, and sore throat and hoarseness were stu...
Anesthesia and analgesia, 2017
Tracheal tube cuff pressures exceeding the perfusion pressures of the tracheal mucosa have been associated with complications such as sore throat, tracheal mucosa ulcers, tracheal rupture, and subglottic stenosis. Despite appropriate inflation, many factors can increase the tracheal cuff pressure during mechanical ventilation. This prospective observational cohort study was designed to test the hypothesis that during a clinical model of decreasing respiratory compliance, the pressure within the endotracheal tube cuff will rise in direct relationship to increases in the airway pressures. Twenty-eight adult obese patients (BMI ≥30 kg/m) scheduled for elective laparoscopic gynecologic procedures were enrolled. All patients received general anesthesia utilizing endotracheal tubes with low-pressure high-volume cuffs. After baseline adjustment of the cuff pressure to 25 cm H2O, the airway pressures and endotracheal cuff pressures were continuously measured using pressure transducers conne...
Effect of Nitrous Oxide Anaesthesia on Endotracheal Cuff Pressure
Haseki Tıp Bülteni, 2017
Aim: When N 2 O is used for general anaesthesia, it diffuses into the air-filled endotracheal cuff causing the cuff pressure to rise by over inflating the cuff, which results in tracheal damage. This study aimed to estimate changes in the endotracheal-cuff pressure with time during oxygen-air-and oxygen-N 2 O-induced anaesthesia and to determine its sore throat and hoarseness incidence. Methods: Fifty patients with American Society of Anesthesiologists physical status 1-2, aged 18-60 years were icluded to our study. Orotracheal intubation was performed using polyvinyl chloride high volume-low pressure endotracheal tubes. The AIR group 40% O 2 /60% air and N 2 O group 40% O 2 /60% N 2 O was used. The endotracheal cuff pressure at 5, 10, 15, 20 minutes immediately after intubation and at 10-minute intervals were recorded. When the cuff pressure reached 45 cm H 2 O, was attenuated to 25-30-cm H 2 O. At the post operative first and the 24th hour, the patients were queried for sore throat and hoarseness. Results: The N 2 O-group cuff pressure rose from the fifth minute onwards. Also, the N 2 O group had a higher incidence of sore throat and hoarseness. Conclusion: N 2 O results in elevated cuff pressure and tracheal morbidities. Cuff-pressure should be routinely monitored during anaesthesia using N 2 O.
IOSR Journal of Dental and Medical Sciences, 2016
Background: LMA exerts pressure on the pharyngeal mucosa which may lead to throat discomfort. Nitrous oxide is known to diffuse into air containing cavity.Nitrous oxide use causes increase in proseal LMA(PLMA)cuff pressure was proved, but whether the resulting increased cuff pressure leading to laryngopharyngeal morbidity which is clinically important remains unclear. We therefore, tested the hypothesis. Methods:Eighty patients are randomly divided into group A(O 2 +Air) and group N(O 2+ N 2 O) each containing 40 Patients using computer generated randomization list. Patients monitored during surgical procedure regarding intraoperative hemodynamic changes , increase in PLMA cuff pressure , number of deflations required and laryngopharyngeal morbidity during intra and postoperatively upto 24 hrs.PLMA cuff pressure was monitored using cuff pressure monitor[VBM Aneroid meter]. Results:There were no significant intraoperative differences between two groups air andnitrous oxide with respect to hemodynamic parameters, but statistically significant (p valve < 0.001) cuff pressure changeswith nitrous oxide use which was exceeding > 60 cms of H2O and upto six deflations to maintain pressure in PLMA were required. There was no statistically significant difference for laryngopharyngeal morbidity, probably because we have limited cuff pressure upto 60 cms of H2O in nitrous oxide group as well in laproscopic surgeries > 3 hrs. Conclusions:Our study concludes that use of cuff pressure monitoring in PLMA to maintain cuff pressure as recommended by the manufacturer probablyreduces the incidence of postoperative pharyngo-laryngeal morbidity. Cuff pressures are increased with nitrous oxide use and repeated deflation of cuff is required. Butpharyngo-laryngeal morbidity can be limited by deflation and monitoring of cuff pressure for nitrous oxide.Nitrous oxide can be safely used forlaproscopic surgeries with PLMA for surgeries lasting less than three hours .
International journal of scientific research, 2017
Introduction: Sore throat due cuff over-inflation induced mucosal ischemia is a common side effect of general anaesthesia especially with N2O.Adequacy of cuff inflation can be easily measured using an aneroid manometer.We studied the effect of N2O and Air on intracuff pressure, the number of cuff deflations needed to maintain a cuff pressure of 25 cm H2O and the severity of sore throat caused by using either as carrier gas. Materials & Method: 100 patients, between age of 18 to 60, ASA I or II physical status undergoing laparoscopic cholecystectomy under general anaesthesia were randomly divided into Group N-a mixture of 50% N2O & 50% O2 was used as carrier gas and Group A-a mixture of 50% Air & 50% O2 was used as carrier gas.Post intubation the endotracheal tube cuff was inflated till a pressure of 25 cm H2O using an aneroid manometer and noted every 10 min. Every time the cuff pressure was found to be above or below 25 cm H2O it was reset to 25 cm H2O.Post-extubation all patients were evaluated for complaint of sore throat in the recovery room and 12 hrs post extubation. Results: The percentage rise in intra-cuff pressure in both groups was comparable for 10 minutes (P=0.644) & 20 minutes (P=0.096) but at 30 min (31.68%) it was highly significant (P < 0.001) in Group N. It was highest at 10 min in both groups, decreasing over time (18.08%) till 150 min in Group N and (1.92%) till 50 min in group A. Severity of sore throat was higher in group N both in recovery room and 12 hours post-operatively. Conclusion: Postoperative tracheal mucosal injuries caused by cuff contact are frequent in patients in whom N2O is use as a carrier gas. We recommend the routine use an aneroid manometer for initial cuff inflation as well as for intraoperative monitoring during surgeries done using a N2O based anaesthesia technique. The initial increase in cuff pressure associated with pneumoperitoneum advocates cuff pressure monitoring in all laparoscopic surgeries regardless of the carrier gas used.
Saudi Journal of Anaesthesia, 2011
Objective: To compare the three common methods of endotracheal tube cuff inflation (sealing pressure, precise standard pressure or finger estimation) regarding the effective tracheal seal and the incidence of post-intubation airway complications. Methods: Seventy-five adult patients scheduled for N 2 O free general anesthesia were enrolled in this study. After induction of anesthesia, endotracheal tubes size 7.5 mm for female and 8.0 mm for male were used. Patients were randomly assigned into one of three groups. Control group (n=25), the cuff was inflated to a pressure of 25 cm H 2 O; sealing group (n=25), the cuff was inflated to prevent air leaks at airway pressure of 20 cm H 2 O and finger group (n=25), the cuff was inflated using finger estimation. Tracheal leaks, incidence of sore throat, hoarseness and dysphagia were tested. Results: Although cuff pressure was significantly low in the sealing group compared to the control group (P<0.001), the incidence of sore throat was similar in both groups. On the other hand, cuff pressure as well as the incidence of sore throat were significantly higher in the finger group compared to both the control and the sealing group (P<0.001 and P=0.008). The incidence of dysphagia and hoarseness were similar in the three groups. None of the patients in the three groups developed air leak around the endotracheal tube cuff. Conclusions: In N 2 O, free anesthesia sealing cuff pressure is an easy, undemanding and safe alternative to the standard technique, regarding effective sealing and low incidence of sore throat.
Anaesthesia, 1983
T h e cffecrs of' nitrous oxide dfjision on tracheal tube ruff pressure folrowing inflation wilh air and .saline were studied ur u temperature of37"C. l'he pressure in the cuff inflated with air increased more rapidly ond to a higiirr k~e l (about 200 mmHg) ihan pressure in the cuffs infiated with saline (ubout 12 mmHg). The hazards of endotracheal intubation. Anna1.r of O t n l q y , Rhinology and Laryngology 1971; 80: 5 5 6 6 4 . STANLEY TH. LIU WS. Tracheostomy and endotracheal tube cuff volume and pressure changes during thoracic operations. Annals of Thoracic Surgrrv 1975; 2 0 144-51.
Indian Journal of Clinical Anaesthesia, 2021
Respiratory dynamics are significantly altered during laparoscopic surgeries. Anesthesiologists should be well versed with the benefits as well as limitations of positive end expiratory pressure (PEEP) during laparoscopy. They can then judiciously use the same in different patient populations. In this study we have compared the effects of ventilation with and without PEEP of 10 cm on blood gases, airway pressures and hemodynamic parameters during laparoscopy. 60 patients, from American Society of Anesthesiologists (ASA) physical status I and II, in the age group of 18 to 60, posted for laparoscopic cholecystectomy were enrolled. They were randomized into two groups of 30 each. Group P received PEEP of 10 cm during laparoscopy and group C did not receive any PEEP. The vital parameters, arterial blood gases, and airway pressures were compared in both groups. The oxygenation, (PaO2/FiO2 ratio) was significantly higher in PEEP group (446. 4 ± 113.32 mm of Hg) as compared to the control ...
Journal of Chitwan Medical College, 2022
Background: Laparoscopic surgeries are commonly performed under general anesthesia using endotracheal intubation. Laryngoscopy and endotracheal intubation cause exaggerated hemodynamic response which may be detrimental to hypertensive patients and those with cardiac issues. I-gel, a second generation supraglottic airway device mitigates this effect and can be safely used under general anesthesia. Methods: This was a prospective comparative study consisting of 64 patients undergoing laparoscopic surgery. The patients were divided into endotracheal tube group and I-gel group, each group with 32 patients, which was done according to convenience sampling method. Patient’s baseline heart rate, systolic, diastolic and mean arterial blood pressure was recorded. These parameters were recorded at one, three and five minutes of placement of airway device, after creating caboperitonium and after extubation which were compared statistically. Results: Exaggerated hemodynamic response was observ...