Changes in uncuffed endotracheal tube leak during laparoscopic inguinal herniorrhaphy in children

Noguchi, Atsushi; Kuga, Kumiko; Tashiro, Naoki; Shimakawa, Yusuke; Shono, Toshiyuki; Hirakawa, Naomi; Saito, Yoshiro

doi:10.1007/s00540-016-2190-5

Cited by 2 publications

(8 citation statements)

References 13 publications

(9 reference statements)

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“…Further, in the event that the tube encountered resistance and did not pass, we performed intubation with a small uncuffed tube. In addition, an uncuffed tube may need to be replaced with another larger diameter tube for adequate ventilation of the airway; in which case, several attempts may sometimes be required before the appropriate size is found [3,8]. In our study, laparotomy and laparoscopic operations in the pediatric patient group were performed with multiple laryngoscopies because of difficulty to pass the vocal cords or leak increase or less target tidal volumes.…”

Section: Discussionmentioning

confidence: 99%

“…If ETT leakage is 20%, the target tidal volume remains below 10% [6]. Disturbance of mechanical ventilation due to target tidal volume, lung compliance, and resistance changes due to ETT leakage is over 20% [4,8]. It is recommended that a large-number tube be used to prevent secondary insufficient tidal volume development to increase ETT leak in pneumoperitoneum or mechanical ventilation, especially in the use of uncuffed ETT in laparoscopic surgeries [10].…”

Section: Discussionmentioning

confidence: 99%

“…Anesthesia management performed during laparoscopic surgery, pathophysiological changes caused by pneumoperitoneum, and close follow-up of changes due to patient position are important. With an increase in intraabdominal pressure, a decrease in tidal volume, an increase in airway resistance, a decrease in pulmonary compensation, [1,8,12,13]. In addition, in laparoscopic surgeries, carbon dioxide gas is absorbed into the bloodstream as a result of the absorption of pneumoperitoneum, causing hypercapnia [12][13][14].…”

Section: Discussionmentioning

confidence: 99%

“…The number of inhalations was adjusted within the limits of etCO 2 25-40 mmHg. The value of ETT leak was calculated ð%Þ = ðTVi − TVeÞ/TVi × 100 [6,8]. A larger number tube size was decided by the attending anesthetist and was based on the existence of PIP > 30 cmH 2 O or TVe < 8 ml/kg or ETT leak > 20% in the MV.…”

Section: Methodsmentioning

confidence: 99%

“…Therefore, to reduce the risk of aspiration in laparoscopic surgery, to prevent multiple laryngoscopies and intubations, and for more accurate monitoring of tidal vol-ume and end-tidal carbon dioxide in ventilation, a cuffed ETT is also used [1,3]. However, the cricoid of the tracheal tubes poses a serious risk of airway damage in children due to the cuff being inserted between the subglottic region and the vocal cords and due to the fact that all pediatric cuffed tubes have the main design defects that can cause airway complications [4,[6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

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Uncuffed Endotracheal Tube Experience in Pediatric Patients with Laparotomy and Laparoscopic Surgeries

Baş

Kayhan

Onay

et al. 2020

BioMed Research International

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Aim. The aim of this study is to compare endotracheal tube leak, tube selection, mechanical ventilation, and side effects in the use of uncuffed tubes in both laparoscopic and laparotomy surgeries in pediatric patients. Material and Method. Patients who underwent laparotomy (LT group) or laparoscopic (LS group) surgery between 1 and 60 months. In the selection of uncuffed tubes, it was also planned to start endotracheal intubation with the largest uncuffed tube and to start intubation with a small uncuffed tube if the tube encounters resistance and does not pass. Mechanical parameters, endotracheal tube size, tube changes, and side effects are recorded. Results. A total of 102 patients, 38 females and 64 males, with a mean age of 10.9±8.1 months, body weight 7.1±3.7 kg, and height 67±15 cm, were included. 54 patients underwent laparoscopic surgery, and 48 patients underwent laparotomy. Tube exchange was performed in a total of 18 patients. In patients who underwent tube exchange, 11 patients were intubated with a smaller ETT number and others endotracheal intubation; when the MV parameters were TVe<8 ml/kg and ETT leak>20%, a larger uncuffed tube was used due to PIP 30 cmH2O pressure. Patients with aspiration were not found in the LT and LS groups. There was no difference in the intergroup evaluation for postoperative side effects such as cough, laryngospasm, stridor, and aspiration. Conclusion. There was no significant difference between the groups in terms of tube changes and side effects. So that we can start with the largest possible uncuffed tube to decrease ETT leak, both laparotomy and laparoscopic operations in children can be achieved with safe mechanical ventilation and target tidal volume.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Uncuffed Endotracheal Tube Experience in Pediatric Patients with Laparotomy and Laparoscopic Surgeries

Baş

Kayhan

Onay

et al. 2020

BioMed Research International

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Frequency of the requirement of inappropriate uncuffed tracheal tube size for pediatric patients: a retrospective observational analysis

2021

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Background The insertion of inappropriately sized uncuffed endotracheal tubes (ETTs) with a tight seal or presence of air leakage may be necessary in children. This study aimed to analyze the frequency of the requirement of inappropriately sized uncuffed ETT insertion, air leakage after the ETT was replaced with one of a larger size, and factors associated with air leakage after ETT replacement. Methods Patients under 2 years of age who underwent oral surgery under general anesthesia with uncuffed ETTs between December 2013 and May 2015 were enrolled. The ETT size was selected at the discretion of the attending anesthesiologists. A leak test was performed after intubation. The ETT was replaced when considered necessary. Data regarding the leak pressure (PLeak) and inspiratory and expiratory tidal volumes were extracted from anesthesia records. We considered a PLeak of 10 < PLeak ≤ 30 cmH2O to be appropriate. The frequencies of the requirement of inappropriately sized ETTs, absence of leakage after ETT replacement, ETT size difference, and leak rate were calculated. A logistic regression was performed, with PLeak, leak rate, and size difference included as explanatory variables and presence of leakage after replacement as the outcome variable. Results Out of the 156 patients enrolled, 109 underwent ETT replacement, with the requirement of inappropriately sized ETTs being observed in 25 patients (23%). ETT replacement was performed in patients with PLeak ≤ 10 cmH2O; leakage was absent after replacement (PLeak < 30 cmH2O) in 52% of patients (25/48). In the multivariate logistic model, the leak rate before ETT replacement was significantly associated with the presence of leakage after replacement (p = 0.021). Conclusions Inappropriately sized ETTs were inserted in approximately 23% of the patients. The leak rate may be useful to guide ETT replacement.

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Changes in uncuffed endotracheal tube leak during laparoscopic inguinal herniorrhaphy in children

Cited by 2 publications

References 13 publications

Uncuffed Endotracheal Tube Experience in Pediatric Patients with Laparotomy and Laparoscopic Surgeries

Uncuffed Endotracheal Tube Experience in Pediatric Patients with Laparotomy and Laparoscopic Surgeries

Frequency of the requirement of inappropriate uncuffed tracheal tube size for pediatric patients: a retrospective observational analysis

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