Endotracheal tube cuff pressure during laparoscopic bariatric surgery: highs and lows

Abstract

Background: Gastric calibration tubes (GCTs) are a unique component of bariatric surgery. This study aimed to assess changes in the endotracheal tube (ETT) cuff pressure during laparoscopic bariatric surgery.Methods: This was a prospective observational study consisting of 124 American Society of Anesthesiologists class I–III morbidly obese patients (body mass index > 40 kg/m2) undergoing elective laparoscopic bariatric surgery under general anesthesia. The baseline ETT cuff pressure was 28 cmH2O. Cuff pressure, peak airway pressure, and hemodynamic changes were observed during various steps of bariatric surgery. Immediate postoperative complications during the first 24 h were recorded. Results: ETT cuff pressure increased significantly from the baseline (28 cmH2O) after insertion of GCT (36.3 ± 7.3 cmH2O) and creation of carboperitoneum (33.3 ± 3.8 cmH2O). Cuff pressure decreased significantly on GCT removal (24.0 ± 3.0 cmH2O) and release of carboperitoneum (24.7 ± 3.0 cmH2O). Peak airway pressure increased from the initial baseline value of 25.1 ± 3.1 to 26.5 ± 4.5 after GCT insertion, creation of carboperitoneum (32.6 ± 4.4), attainment of reverse Trendelenburg position (32.3 ± 4.0), and subsequent return to supine position 32.5 ± 4.8.Conclusions: The endotracheal cuff pressure significantly varies during the intraoperative period. Routine monitoring and readjustment of cuff pressure are advisable in all laparoscopic bariatric surgeries to minimize the possibility of postoperative complications.

Comparison of the effect of pressure control and volume control ventilation on endotracheal tube cuff pressure in patients undergoing general anesthesia and mechanical ventilation: a parallel randomized clinical trial

“…The results of this study showed that the ETCP varies significantly during this surgery. So that this pressure was significantly reduced during the removal of gastric calibration tubes (GCTs) and the release of the carbo peritoneum [ 17 ]. Also, the results of the study by Athiraman et al (2015), in which they examined cuff pressure changes with position change in patients undergoing neurologic surgery, showed that cuff pressure decreased significantly over time [ 18 ].…”

Risk factor evaluation of cuff pressure of >30 cmH2O to stop air leakage during mechanical ventilation: A prospective observational study

“…In general, an endotracheal tube cuff pressure of 20–30 cmH 2 O is recommended to create an adequate seal between the tube and trachea (Ferreira et al., 2021 ; Saxena et al., 2022 ; Wang et al., 2021 ). However, several studies have revealed that a cuff pressure of >30 cmH 2 O is required for some patients during mechanical ventilation (Nseir et al., 2009 ; Peters & Hoogerwerf, 2013 ; Rosero et al., 2018 ; Wu et al., 2021 ).…”

“…In general, an endotracheal tube cuff pressure of 20-30 cmH 2 O is recommended to create an adequate seal between the tube and trachea (Ferreira et al, 2021;Saxena et al, 2022;Wang et al, 2021).…”