Effects of decreasing endotracheal tube cuff pressures during neck retraction for anterior cervical spine surgery

Abstract

<jats:p content-type="fine-print"><jats:italic>Object.</jats:italic> The authors' goal was to determine whether the incidence of postoperative sore throat, hoarseness, and dysphagia associated with anterior spine surgery is reduced by maintaining endotracheal tube cuff pressure (ETCP) at 20 mm Hg during the period of neck retraction.</jats:p> <jats:p content-type="fine-print"><jats:italic>Methods.</jats:italic> Fifty-one patients scheduled for anterior cervical spine surgery were enrolled. After intubation, ETCP was adjusted to 20 mm Hg in all patients. Following placement of neck retractors, ETCP was measured. Patients were randomized to a control (no adjustment) or treatment group (ETCP adjusted to 20 mm Hg). A blinded observer questioned the patients about the presence of sore throat, dysphagia, and hoarseness at 1 hour, 24 hours, and 1 week postoperatively.</jats:p> <jats:p content-type="fine-print">No differences between groups at 1 hour postoperatively were demonstrated. At 24 hours, 51% of patients in the treatment group complained of sore throat compared with 74% of control patients (p &lt; 0.05). Sixty-five percent of the women experienced sore throat compared with 35% of the men (p &lt; 0.05). At 24 hours, longer retraction time correlated with development of dysphagia (p &lt; 0.05, r<jats:sup>2</jats:sup> = 0.61). At 24 hours, hoarseness was present in 65% of women and 20% of men (p &lt; 0.05).</jats:p> <jats:p content-type="fine-print"><jats:italic>Conclusions.</jats:italic> The results of this study suggest the following three predictors of postoperative throat discomfort following anterior cervical spine surgery in which neck retraction is performed: increased ETCP during neck retraction (sore throat), neck retraction time (dysphagia), and female sex (sore throat and hoarseness). The simple maneuver of decreasing ETCP to 20 mm Hg may be helpful in improving patient comfort following anterior cervical spine surgery.</jats:p>

Assessment of Endotracheal Cuff Pressure by Continuous Monitoring: A Pilot Study

“…27,28,52,53 In our study, patients who were more sedated and had a lower GCS score had less variation in pressure compared with patients who were less sedated and had higher GCS scores. More frequent monitoring of cuff pressure may be needed in patients who are less sedated with a higher level of consciousness who have greater fluctuation in cuff pressures.…”

“…Complications of overinflation of the cuff include nerve palsy, 21 tracheoesophageal fistula, 22 tracheal wall damage, 23 subglottic scarring or stenosis, 24,25 and hoarseness. 26,27 Management of endotracheal tube cuff pressure based on routine cuff pressure monitoring has resulted in fewer reported complications associated with overinflation. Underinflation of the endotracheal tube cuff is associated with inadequate delivery of prescribed tidal volume and aspiration of secretions.…”

Effect of perioperative steroids on dysphagia after anterior cervical spine surgery: A systematic review

“…Perioperative steroids should probably be used in conjunction with other methods for multilevel procedures, such as limiting retraction time 30,31 and cuff pressure, 10 with the hope of achieving even greater reduction in post-operative dysphagia.…”

“…2,11 Given that dysphagia is a common complication of anterior cervical spine surgery, numerous techniques have been investigated to decrease its incidence, decreased plate prominence and cuff pressure are just a few. 2,4,10,11 One therapeutic intervention that shows promise is the use of perioperative steroids. [12][13][14][15][16][17][18] By reducing the inflammatory response, steroids should decrease dysphagia as well as pain in the postoperative period.…”

“…Contributing factors include prevertebral soft tissue swelling, vocal cord paresis, 4,6,7 scar tissue formation, hardware complication and cervical graft material. 1,4,8 Risk factors that have been identified include multilevel fusion and female gender, 3,4,9,10 revision surgery, 5 and plate prominence. 2,11 Given that dysphagia is a common complication of anterior cervical spine surgery, numerous techniques have been investigated to decrease its incidence, decreased plate prominence and cuff pressure are just a few.…”