Intraoperative Measurement of Endotracheal Tube Cuff Pressure and Its Change During Surgery in Correlation With Recurrent Laryngeal Nerve Palsies, Hoarseness, and Dysphagia After Anterior Cervical Discectomy and Fusion: A Prospective Randomized Controlled Trial

Abstract

Study Design Prospective randomized controlled trial. Objectives Adjustment of endotracheal tube cuff pressure (ETCP) in anterior cervical discectomy and fusion (ACDF) may influence the incidence of complications such as recurrent laryngeal nerve palsy (RLNP), hoarseness, and dysphagia. Methods The prospective randomized controlled trial was designed to investigate the influence of ETCP on the incidence of postoperative complications. All eligible patients underwent vocal cord examination before and after ACDF and were randomized into a control group (CG) and intervention group (IG). Endotracheal tube cuff pressure was passively monitored in CG, and in IG, it was maintained at 20 mmHg. Outcomes were evaluated during hospitalization and during follow-up. Results A total of 98 patients were randomized, each group consisted of 49 patients. Statistical analysis showed that gender and age did not influence the incidence of complications. In CG, duration of retractor placement and extent of approach significantly impacted the occurrence of complications. The incidence of postoperative RLNP was 8.2% in IG and 12.2% in CG, hoarseness and dysphonia were present in 18.4% in IG and in 37.5% in CG, and dysphagia in 20.8% in IG and in 22.5% in CG. Hoarseness was significantly present more in CG ( P = .018). Only one patient from CG presented with RLNP after 1 year, the remaining nine patients spontaneously recovered. Conclusions Unregulated ETCP can lead to a significantly higher incidence of hoarseness; however, its improvement rate is 100%. The early postoperative complication rate was higher in CG, and after one year, 1 patient had RLNP and 1 patient had dysphagia.

A systematic review of risk factors and adverse outcomes associated with anterior cervical discectomy and fusion surgery over the past decade

“…We identified 12 prospective cohort studies[ 7 8 11 12 13 14 16 19 20 21 22 23 ] and 16 retrospective cohort studies. [ 6 9 10 15 24 25 26 27 28 29 30 31 32 33 34 35 ] Across all studies ( n = 4270), the rate of postoperative dysphagia at any point of time was 7.9%.…”

“…Among prospective studies ( n = 1707), overall rates of postoperative dysphagia ranged from 0.5% to 34.5% with a pooled incidence of 11.1%. Among prospective studies reporting chronic dysphagia (lasting longer than 3 months)[ 13 14 16 23 ] ( n = 537), this rate ranged from 1.1% to 32% with overall rate of chronic dysphagia of 13.3%. Among retrospective studies ( n = 2563), overall rates of postoperative dysphagia ranged from 0.5% to 24.3% with a pooled incidence of 5.8%.…”

“…Two prospective studies[ 8 16 ] [ Table 2 ] confirmed that in contrast to ACP, ZP anchored cage systems in ACDF considerably reduced the incidence of postoperative dysphagia. Two prospective studies: one of 108 patients[ 12 ] [ Table 2 ] and another of 98 patients[ 23 ] reported that unregulated endotracheal cuff pressure (ETCP) could lead to a significantly higher incidence of hoarseness and dysphagia (22.5% and 20.4%) causing the compression of laryngeal tissue during retraction and intubation. Yagi et al .…”

Endotracheal Tube Cuff Inflation Pressure awareness and response to education among anesthesia technicians

“…Using a manometer may cause underestimation of the recorded ETT cuff pressure. Because of the internal manometer chamber and pressure equalization, air leaks when the external balloon is connected to the manometer (9). In our study, high-volume, low-pressure endotracheal tubes of the same brand were used in all patients.…”

Dysphagia as a Postoperative Complication of Anterior Cervical Discectomy and Fusion

“…Intraoperative placement of an esophageal temperature probe significantly improved postoperative dysphagia scores in patients undergoing two-level ACDF at two weeks and six months postoperatively [ 91 ]. The adjustment of endotracheal tube-cuff pressure in ACDF does not have a significant impact on the incidence of postoperative dysphagia [ 92 ].…”