The Professional Experience of Anaesthesiologists in Proper Inflation of Laryngeal Mask and Endotracheal Tube Cuff

Abstract

Objective: Cuffs inflated to inappropriately high pressures cause ischemia, reducing tracheal mucosal blood flow, while cuffs inflated at lower pressure than necessary give rise to inadequate ventilation, aspiration of gastric contents, or extubation due to air leakage. In this study, we aimed to investigate the effect of the experience of anaesthesia staff on endotracheal tube and laryngeal mask airway cuff inflation. Methods:The study included 348 elective patients scheduled to undergo surgery under general anaesthesia, with 34 anaesthesia technicians, 16 anaesthesia residents, and 12 anaesthesiologists with different years of professional experience. The participants were told to inflate the cuff balloon with air to the level of the pressure that was appropriate for them. No information was provided to the participants about the values of the cuff pressure pending the completion of all measurements. After placement of the laryngeal mask airway and endotracheal tube, the success of the procedure was checked by monitoring square-wave capnograph tracing and thoracoabdominal motion. Each participant performed the procedures on three patients, and the mean cuff pressures were measured. Results:There was no significant correlation between duration of experience of technicians, residents, and experts in using laryngeal mask airway pressure (r=-0.192/p=0.278, r=0.225/p=0.402, r=-0.476/p=0.118, respectively) and endotracheal tube (r=-0.306/ p=0.079, r=-0.060/p=0.826, r=-0.478/0.116, respectively). Conclusion:It has been concluded that professional experience does not contribute to achieving normal cuff pressure without monitoring. Introduction of the cuff manometer into routine anaesthesia practice will be useful, irrespective of anaesthesiologists' experience.

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

“…It has been shown to overinflate the cuff in 30-98% of cases, depending on the type of ETT used and the population studied (15). Saraçoğlu et al (16) found no significant relationship between anesthesiologist experience and adequacy of ETT cuff pressure when patients were instructed to inflate the cuff to the level they considered appropriate(17)(17)(17) manually. Bulamba et al (18) suggest using a loss-ofresistance syringe as an alternative to simple palpation.…”

Anestesisykepleieres metoder for å kontrollere cufftrykk – en observasjonsstudie

“…Wujtewicz og Sawicka ( 30) viste derimot at cufftrykkene økte ved økt erfaring. Andre studier viser ingen signifikant forskjell mellom erfaring og cufftrykk (8,31,32). Selv om det var et økt antall akseptable cufftrykkverdier ved økt erfaring i Ozer og Demirel (11) sin studie, var over halvparten (56 %) av cufftrykkene til de mest erfarne utenfor de akseptable grensene.…”

Measuring endotracheal tube intracuff pressure: no room for complacency

“…The rapid, qualitative evaluation of the pilot balloon via manual palpation can serve as a surrogate estimation of intracuff pressure, but this method is subject to inherent inaccuracies and does not provide any quantitative data. Saraçoğlu et al [62] demonstrated that there was no significant correlation between the experience of the anaesthesia provider and the appropriateness of the ETT intracuff pressure when subjects were instructed to manually inflate the cuff to what they deemed as an appropriate amount. Harm et al [63] showed that not only do anaesthesia providers frequently misjudge pressures but persons responsible for prehospital intubations do as well.…”