K-Y™ jelly inhibits increase in endotracheal tube cuff pressure during nitrous oxide exposure in vitro

Abstract

BackgroundThe increase in endotracheal tube cuff pressure due to nitrous oxide diffusion is a well-known risk during general anesthesia using nitrous oxide. We hypothesized that lubricating endotracheal tube cuffs with K-Y™ Jelly might inhibit the increase in cuff pressure that occurs during exposure to nitrous oxide.MethodsWe used two types of endotracheal tube cuffs: one made from ultrathin polyurethane (PU) and another made from conventional polyvinyl chloride (PVC). Using a pediatric trachea model, which consisted of an acrylic cylinder with an internal diameter of 12 mm, we measured changes in the cuff pressure during nitrous oxide exposure in size 5.0-mm internal diameter endotracheal tubes with each type of cuff, with and without lubrication with K-Y™ Jelly.ResultsDuring nitrous oxide exposure, the increase in cuff pressure was significantly lower in the lubricated cuffs than in the non-lubricated cuffs in both types of cuffs (PVC, P < 0.0001; PU, P < 0.0001). However, the cuff compliance in the trachea model was unaffected by lubrication in both types of cuffs.ConclusionsLubrication of endotracheal tube cuffs with K-Y™ Jelly may effectively delay the increase in cuff pressure that occurs during general anesthesia using nitrous oxide.

Effect of endotracheal tube lubrication on cuff pressure increase during nitrous oxide exposure: a laboratory and prospective randomized controlled trial

“…To test whether lubrication with K-Y™ jelly inhibits cuff pressure increase during N 2 O exposure in a dose-dependent manner, groups were formed based on the amount of K-Y™ jelly used: 0 g, 1 g, and 3 g for laboratory study 1. Lubrication was performed as described earlier [10]. After adjusting the cuff pressure to 15 mmHg (approximately 20 cmH 2 O), we measured the cuff pressures in the trachea model under the three different lubrication conditions consecutively at a room temperature of 24 °C under continuous flushing with 3 L/min of 66% N 2 O in oxygen at 20 min, 40 min, and 60 min of N 2 O exposure, respectively.…”

“…Furthermore, ETT cuff pressure monitoring during general anesthesia using N 2 O is recommended to ensure that the cuff pressure remains within safe limits to avoid airway morbidity in children [6, 7] and adults [8, 9]. Consequently, monitoring and adjusting the cuff pressure of an ETT during general anesthesia should be performed carefully as standard clinical practice, particularly if N 2 O is used [10].…”

“…In our previous study, we found that the application of K-Y™ jelly (Johnson & Johnson, New Brunswick, NJ, USA) on the ETT cuff surface inhibited an increase in cuff pressure during N 2 O exposure in vitro [10]. However, we found several critical differences between our previous laboratory study and existing clinical conditions, which may limit the extrapolation of these results to the clinical setting [10]. We have chosen two major factors whose influences on the effects of lubrication we will assess.…”

“…First, the amount of K-Y™ jelly retained on the cuff may be reduced during tracheal intubation, and part of the lubricant may be washed out with time during ventilation, suggesting that the inhibitory effect of lubrication may decrease in clinical settings. Second, since all experiments in our previous laboratory study were conducted at a room temperature of 24 °C [10], it is unclear how lubrication influences the N 2 O-induced cuff pressure increase at body temperature. Therefore, in the current study, we sought to study how a reduction in the amount of K-Y™ jelly and a rise in temperature affect the inhibitory effects of lubrication on cuff pressure increase during N 2 O exposure in vitro and to determine whether the inhibitory effects of K-Y™ jelly [10] hold true in clinical settings.…”

Detrimental Effects of Filling Laryngotracheal Airways To Excessive Pressure (DEFLATE-P): a quality improvement initiative

“…Interestingly, two studies comparing open abdominal surgery to laparoscopic techniques revealed that manometrymeasured endotracheal tube (ETT) cuff pressures significantly increased after abdominal insufflation or Trendelenburg positioning, and subsequently resulted in more frequent POST events [12,13]. Koyama et al demonstrated that the application of lubricant to the cuff can prevent such increases in pressure via a reduction of gas diffusion into the cuff [14]. Another study compared a novel laryngeal mask airway (LMA) with intra-cuff pressure measurement versus a traditional LMA, finding a significant reduction in postoperative pharyngolaryngeal complications [15].…”