Changes in endotracheal tube cuff pressure during laparoscopic surgery in head-up or head-down position

Abstract

BackgroundThe abdominal insufflation and surgical positioning in the laparoscopic surgery have been reported to result in an increase of airway pressure. However, associated effects on changes of endotracheal tube cuff pressure are not well established.Methods70 patients undergoing elective laparoscopic colorectal tumor resection (head-down position, n = 38) and laparoscopic cholecystecomy (head-up position, n = 32) were enrolled and were compared to 15 patients undergoing elective open abdominal surgery. Changes of cuff and airway pressures before and after abdominal insufflation in supine position and after head-down or head-up positioning were analysed and compared.ResultsThere was no significant cuff and airway pressure changes during the first fifteen minutes in open abdominal surgery. After insufflation, the cuff pressure increased from 26 ± 3 to 32 ± 6 and 27 ± 3 to 33 ± 5 cmH2O in patients receiving laparoscopic cholecystecomy and laparoscopic colorectal tumor resection respectively (both p < 0.001). The head-down tilt further increased cuff pressure from 33 ± 5 to 35 ± 5 cmH2O (p < 0.001). There six patients undergoing colorectal tumor resection (18.8%) and eight patients undergoing cholecystecomy (21.1%) had a total increase of cuff pressure more than 10 cm H2O (18.8%). There was no significant correlation between increase of cuff pressure and either the patient's body mass index or the common range of intra-abdominal pressure (10-15 mmHg) used in laparoscopic surgery.ConclusionsAn increase of endotracheal tube cuff pressure may occur during laparoscopic surgery especially in the head-down position.

Evaluation of Endotracheal Tube Cuff Pressure in Laparoscopic Cholecystectomy and Postoperative Sore Throat

“…This can be explained by the fact that change in the cuff pressure is insignificant in RTB position as compared to that of trendelenburg position. This finding is supported by study conducted by Wu et al 4 Cuff pressure is not monitored routinely in anesthetic practice. Even short duration surgery can lead to postoperative airway complication when cuff pressure exceeds tracheal mucosal perfusion pressure.…”

Comparison of the endotracheal tube cuff pressure between a tapered- versus a cylindrical-shaped cuff after changing from the supine to the lateral flank position

“…In general, it is well known that various positional changes and head movements can displace the ETT tube in tracheally intubated patients. [11][12][13][14][15][16][17] Head extension can result in cephalad migration of the ETT, whereas head flexion can result in caudal displacement. 12,18 Lateral rotation of the head can cause movement of the ETT tip in both directions.…”

“…[7][8][9][10] Positional change and neck movement after intubation can displace an ETT in a patient's trachea. [11][12][13][14][15][16][17][18] Intratracheal migration of the ETT due to a change in patient positioning can result in a change in the ETT cuff pressure because the trachea is not cylindrical. [19][20][21][22] When the ETT migrates proximally toward the vocal cords, the cuff shape may be distorted and the intracuff volume may be compressed at a narrower and less compliant upper airway space such as at the level of the cricoid cartilage.…”

Comparison of the cuff pressure of a TaperGuard endotracheal tube and a cylindrical endotracheal tube after lateral rotation of head during middle ear surgery

“…[1–4] In the tracheal cartilages, the cricoids cartilage is the only round shape, followed by C-shaped tracheal cartilages. Therefore, a positional change causes displacement of an ETT in the trachea, which may affect the cuff pressure.…”