Changes in cuff pressure and position of cylindrical-cuff and tapered-cuff tracheal tubes during laparoscopic abdominal surgery

Abstract

Objectives: To evaluate changes in cuff pressure and position of tapered-cuff and cylindrical-cuff tracheal tubes (TTs) during laparoscopic cholecystectomy; to compare the frequency of endobronchial intubation and airway complaints with the two types of TT. Methods: Patients were randomly assigned to intubation with a TT with a cylindrical cuff (group C) or a tapered cuff (group T). Anaesthesia was maintained with sevoflurane, O 2 and N 2 O after intubation. TT cuffs were inflated to 20 cm H 2 O; changes in cuff pressure and volume were measured up to 30 min after the start of N 2 O use. Distance between the TT tip and the carina was measured before and after pneumoperitoneum and position change. Frequency of sore throat, dysphagia and hoarseness in the two groups was recorded. Results: Cuff volume and pressure were significantly lower in group T than in group C (n ¼ 32 per group). Cuff pressure and volume significantly increased 30 min after start of N 2 O use in both groups. Distance from the TT tip to the carina decreased during surgery in both groups. There were no cases of endobronchial intubation, and there were no between-group differences in the frequency of airway complaints. Conclusions: The tapered cuff was associated with a smaller change in cuff pressure during laparoscopic cholecystectomy than the cylindrical cuff, and therefore may be associated with increased preservation of tracheal mucosal perfusion.

Tracheal Tube Design and Ventilator-Associated Pneumonia

“…To our knowledge, no data are available on the safety or the cost-effectiveness of tapered-cuff tracheal tubes. Shin et al 57 showed that in anesthetized subjects receiving N 2 O, P cuff was significantly lower in subjects with tapered-cuff compared with those with standard-cuff tracheal tubes. However, the number of included subjects was small, P cuff was not continuously measured, and clinical signs of tracheal lesions were similar in the 2 groups.…”

A Tapered Cuff Tracheal Tube Decreases the Need for Cuff Pressure Adjustment After Surgical Retraction During Anterior Cervical Spine Surgery: A Randomized Controlled, Double-Blind Trial

“…Supplementary Table 2 shows the intraoperative cuff pressures. The median (IQR) cuff pressures (mm Hg) were significantly lower for the tapered cuff than for the control cuff after tracheal intubation [9 (7-12) vs. 11 (8)(9)(10)(11)(12)(13)(14); P = 0.009)], after neck extension [9 (7-12) vs. 12 (10-15); P < 0.001] and after retraction [18 (15-23) vs. 25 (18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31); P = 0.007, Figure 3A]. Pressure differentials (i.e., pre-post change) caused by surgical retraction and pressure adjustment were smaller in the tapered group than in the control group (Figure 3D).…”

“…Fluid or air leak was less around a tapered cuff than around a conventional cylindrical high-volume low-pressure cuff ( 11 , 12 ). Tapered cuffs also achieve a better air seal with reduced cuff pressure ( 13 ), thereby leading to a smaller change in cuff pressure during compressive forces such as pneumoperitoneum in laparoscopic surgery ( 14 ). There is evidence suggesting tapered cuffs reduce the incidence of postoperative sore throat and dysphonia ( 15 ).…”

Effects of three endotracheal tube cuff pressure control measures on microaspiration of gastric content: Study protocol for randomised controlled trial

“…ETT cuff pressure is affected by environmental circumstances/factors and therapeutic interventions/factors (Khalil et al, 2019). These factors are body positions (Lizy et al, 2011; Athiraman et al, 2015), peak inspiratory pressure (PIP) (Chenelle et al, 2015), core body temperature (Lizy et al, 2011; Erolçay et al, 2002), blood pressure, the opening of the sternum and pleura (Erolçay et al, 2002), nitrous oxide use (Shin et al, 2015), ventilator pressures, tracheal aspiration (Lizy et al, 2011) and agitation (Sole et al, 2009). These factors cause a decrease or increase in the cuff volume, resulting in a deviation from its normal value.…”