The Effect of Position Changing on Endotracheal Tube Cuff Pressure and Post-Operation Sore Throat and Hoarseness in Patients Undergoing General Anesthesia

Document Type : Original

Authors

1 Department of Anesthesiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

2 Clinical Research Development Unit, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran. Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.

Abstract

Introduction:
Endotracheal intubation is a standard procedure for securing and maintaining the airway during general anesthesia. Cuff pressure must be within the correct range to avoid serious airway complications. This study aimed to assess how the pressure in the endotracheal tube cuff changes when the patient’s position is altered.
Materials and Methods:
This prospective, observational study was conducted on 85 patients aged 18 to 75 undergoing general anesthesia for surgery. Endotracheal intubation was performed with an appropriately sized tube, and the tube cuff was inflated with air using a syringe. The cuff pressure of the endotracheal tube was then assessed using a cuff manometer immediately after intubation and position change, 5 minutes after each, and every 15 minutes until the end of the surgery. Based on the formula for testing the difference between two means for a quantitative trait in two populations, and considering an alpha of 0.05 and a beta of 0.2, the sample size was calculated as 20 individuals in each group of patients with different positions.
 Results:
The endotracheal cuff pressure increased in all three positions, including prone, right lateral, and left lateral. A significant relationship was also observed between the sore throat one hour after extubation and the prone position.
Conclusion:
The ETT cuff pressure increased or decreased outside the normal range in most patients undergoing surgeries that require changing positions. Therefore, we recommend close and continuous monitoring of cuff pressure during anesthesia.

Keywords

Main Subjects


  1. Letvin A, Kremer P, Silver PC, Samih N, Reed-Watts P, Kollef MH. Frequent Versus Infrequent Monitoring of Endotracheal Tube Cuff Pressures. Respir Care. 2018;63(5):495-501.
  2. Sultan P, Carvalho B, Rose BO, Cregg R. Endotracheal tube cuff pressure monitoring: a review of the evidence. J Perioper Pract. 2011;21(11):379-86.
  3. Lizy C, Swinnen W, Labeau S, Poelaert J, Vogelaers D, Vandewoude K, et al. Cuff pressure of endotracheal tubes after changes in body position in critically ill patients treated with mechanical ventilation. Am J Crit Care. 2014;23(1):e1-8.
  4. Lee J, Reynolds H, Pelecanos AM, van Zundert AA. Bi-national survey of intraoperative cuff pressure monitoring of endotracheal tubes and supraglottic airway devices in operating theatres. Anaesth Intensive Care. 2019;47(4):378-84.
  5. Park JH, Lee HJ, Lee SH, Kim JS. Changes in tapered endotracheal tube cuff pressure after changing position to hyperextension of neck: A randomized clinical trial. Medicine (Baltimore). 2021;100(29): e26633.
  6. Rosero EB, Ozayar E, Eslava-Schmalbach J, Minhajuddin A, Joshi GP. Effects of Increasing Airway Pressures on the Pressure of the Endotracheal Tube Cuff During Pelvic Laparoscopic Surgery. Anesth Analg. 2018; 127(1): 120-5.
  7. Kim HC, Lee YH, Kim E, Oh EA, Jeon YT, Park HP. Comparison of the endotracheal tube cuff pressure between a tapered- versus a cylindrical-shaped cuff after changing from the supine to the lateral flank position. Can J Anaesth. 2015; 62(10): 1063-70.
  8. Kim D, Jeon B, Son JS, Lee JR, Ko S, Lim H. The changes of endotracheal tube cuff pressure by the position changes from supine to prone and the flexion and extension of head. Korean J Anesthesiol. 2015;68(1):27-31.
  9. Minonishi T, Kinoshita H, Hirayama M, Kawahito S, Azma T, Hatakeyama N, et al. The supine-to-prone position change induces modification of endotracheal tube cuff pressure accompanied by tube displacement. J Clin Anesth. 2013; 25(1):28-31.
  10. Okgun Alcan A, Yavuz van Giersbergen M, Dincarslan G, Hepcivici Z, Kaya E, Uyar M. Effect of patient position on endotracheal cuff pressure in mechanically ventilated critically ill patients. Aust Crit Care. 2017;30(5):267-72.
  11. Mizuno S, Glowacki J. Low oxygen tension enhances chondroinduction by demineralized bone matrix in human dermal fibroblasts in vitro. Cells Tissues Organs. 2005;180(3):151-8.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

  1. Lorente L, Blot S, Rello J. Evidence on measures for the prevention of ventilator-associated pneumonia. Eur Respir J. 2007; 30(6): 1193-207.
  2. Liu J, Zhang X, Gong W, Li S, Wang F, Fu S, et al. Correlations between controlled endotracheal tube cuff pressure and postprocedural complications: a multicenter study. Anesth Analg. 2010;111(5):1133-7.
  3. Brown BM, Oshita AK, Castellino RA. CT assessment of the adult extrathoracic trachea. J Comput Assist Tomogr. 1983;7(3):415-8.