Monitoreo de presión de manguito de tubo endotraqueal / Monitoring endotracheal tube cuff pressure

OBJECTIVE: Perform an objective monitoring of the endotracheal tube cuff pressure in patients under general anesthesia in the Anesthesiology Service of Hospital Privado de Córdoba. METHODS: It is a controlled, comparative, prospective study where the range of cuff pressures was analyzed at the beginning and end of surgery. A Rush brand manometer (Endotest) was used to perform the measurement. This pressure was related to the patient's data (sex, age, BMI, duration of surgery, endotracheal tube diameter). RESULTS: The total sample was 74 patients, and an initial inflation pressure outside the normal range was found in 75.7 percent of the patients of which 48.6 percent was out of the normal range and 27 percent was below of the normal range. At the end of the surgery it was found that 81.8 percent was within normal values. CONCLUSION: It is mandatory to monitor endotracheal tube cuff pressure in patients under general anesthesia.

OBJETIVOS: Realizar un monitoreo de forma objetiva de la presión del manguito de tubo endotraqueal en los pacientes bajo anestesia general en el servicio de Anestesiología del Hospital Privado de Córdoba. MATERIAL Y MÉTODOS: Es un estudio controlado, comparativo, prospectivo donde se analizo el rango de presiones del manguito al inicio y al final de la cirugía. Se utilizo un manometro de marca Rush (Endotest) para realizar la medición. Esta presión se la relaciono con los datos del paciente (sexo, edad, IMC, duración de cirugía, diámetro de tubo endotraqueal). RESULTADOS: El total de la muestra fueron 74 pacientes, y se encontró una presión de inflado inicial fuera de rango normal en un 75,7 por ciento, de los cuales un 48,6 por ciento fue elevado y un 27 por ciento por debajo del rango normal. Al final de la cirugía se comprobó que el 81,8 por ciento estaba dentro de valores normales. CONCLUSIÓN: Es mandatorio el monitoreo de presión del manguito del tubo endotraqueal en todos los pacientes bajo anestesia general.

A case of Difficult Tracheal Extubation of an Armoured Endotracheal Tube.

Use of repeatedly ETO sterilized armoured endotracheal tube is routine practice in our set up. Hereby we discuss a case of difficult tracheal extubation following prolonged intubation i.e. 11 hours for neuro surgical operation. The details of the procedure and causes are discussed.

The Effects of the Alkalinization of Intracuff Lidocaine after Nitrous Oxide Anesthesia / 대한마취과학회지

BACKGROUND: Diffusion of nitrous oxide into the cuff of the endotracheal tube (ETT) results in an increase in cuff pressure. This method was used to test whether tracheal morbidity is related to fill the cuff of the endotracheal tube with alkalinized lidocaine instead of air or lidocaine only. METHODS: Adult patients scheduled for total thyroidectomy surgery were randomly enrolled (n = 30 for each group).The ETT cuff was filled with air 6 ml (Group C), with 2% lidocaine 6 ml (Group L), or with alkalinized lidocaine (4 ml or 2 ml of 2% lidocaine) using 2 ml (Group A) or 4 ml (Group B) of 8.4% NaHCO3.After tracheal extubation, sore throat was evaluated by visual analog scale as the main end-point of the study. RESULTS: Compared with group air or lidocaine only, the alkalinized-lidocaine groups had a significant reduction in sore throat during the 24-h postoperative period (P < 0.001).The difference was not significant between the two alkalinized lidocaine groups. Cough before tracheal extubation, nausea, postoperative vomiting, dysphonia, and hoarseness after extubation were decreased in the alkalinized-lidocaine groups compared with Group C and L, and a better tolerance was recorded with alkalinized-lidocaine groups compared with Group C and L. CONCLUSIONS: We concluded that use of intracuff alkalinized lidocaine is an effective adjunct to endotracheal intubation instead of air or lidocaine only during nitrous oxide anesthesia, however there were no differences between two alkalinizations.

Postoperative Tracheal Mucosa Ischemia by Endotracheal Tube Cuff Pressure Change During the Anterior Cervical Spine Surgery

OBJECTIVE: Endotracheal tube cuff-pressure(ETCP) increases significantly during anterior cervical spine surgery with neck retraction. Clinically, postoperative hoarseness with sore throat is correlated with vocal cord edema due to longer intubation time and higher ETCP during neck retraction. METHODS: Fifty patients of anterior cervical spine surgery were randomized to a control (no adjustment, 25 cases) and a treatment group (ETCP adjusted to 20mmHg, 25 cases). Patients were blinded to their group assignments. They were questioned about the presence of ischemic symptoms (sore throat, dysphagia, hoarseness) postoperatively at different time points; 4 hours, 24 hours, and 1 week postoperatively. RESULTS: No differences between groups at 4 hours and 1 week postoperatively were demonstrated. At 24 hours, 36% of patients in the treatment group complained of sore throat while 56% of control group patients did (p<0.05). Female patients correlated with development of all ischemic discomfort (p<0.05: sore throat, hoarseness, dysphagia). CONCLUSION: Our results suggest that postoperative ischemic symptom following anterior cervical spine surgery may be associated with the two predictors; increased ETCP during neck retraction and female. The simple procedure of maintaining ETCP to 20mmHg can prevent postoperative tracheal ischemic symptom.

The Effect of Endotracheal Tube Cuff Filled with Lidocaine and Sodium Bicarbonate Mixture on Postoperative Sore Throat and Hoarseness Following General Endotracheal Anesthesia / 대한마취과학회지

BACKGROUND: Postintubational sore throat and hoarseness are usually mild symptoms but they are very common complaints among the patients after endotracheal general anesthesia. In addition, some might have severe discomfort and need invasive procedure to relieve these problems. We tried new method of endotracheal tube cuff filling with local anesthetics to reduce postoperative sore throat and hoarseness and evaluated the results. METHODS: Endotracheal cuff filling was done with air 5 ml in healthy 20 patients (ASA I-II, control group). And in another healthy (ASA I-II) 35 patients, the cuffs were filled with 4% lidocaine 3.5 ml and 8.4% sodium bicarbonate 1.5 ml mixture. After 24 hours following general anesthesia, patients were visited and asked whether there were sore throat or hoarseness, if any, how the degree was. RESULTS: In lidocaine-treated group, the incidence of postintubational sore throat was less compared to control group significantly. There was no difference in incidence of hoarseness between two groups. CONCLUSION: Endotracheal cuff filled with lidocaine and sodium bicarbonate mixture is suggested as an effective protective method that reduces the frequency of postintubational sore throat.

A comparison of arterial blood gas values depending on the use of endotracheal tube cuff in postanesthetic patients / 대한마취과학회지

An endotracheal tube (ETT) may be thought of as a mechanical burden to a spontaneously breathing patient because increases in airway resistance might result in increases in the work of breathing,when diameter of airway is decreased in the intubated patient compared with his own tracheal diameter. We hypothesized that air removal from ETT cuff would permit the airflow between ETT and tracheal wall and could make the airway resistance decrease. Postanesthetic patients after abdominal surgery were divided into two groups. ETT cuff was inflated in group 1 (n=25) and deflated in group 2 (n=25), while 5 l/min of oxygen was delivered through the ETT via a simple oxygen supplement device without a gas reservoir. The effects of balloon on gas exchange and respiratory pattern were evaluated at 5 and 30 minutes after admission to the recovery room. Postanesthetic PaO2 was increased compared to preanesthetic value with oxygen supply. PaCO2 values revealed no significant changes in preanesthetic and postanesthetic periods. Postanesthetic respiratory rate was increased significantly but there was no difference between two groups. However, there were three hypoxemic patients whose PaO2 were below 70mmHg in group 1. It was concluded that the use of balloon of ETT in postanesthetic recovery period might contribute to airway resistance and the work of breathing. Although almost of patients could make compensations to overcome the effects of balloon, there is a risk of postoperative hypoxemia if compensated inadequately.