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      Is sealing cuff pressure, easy, reliable and safe technique for endotracheal tube cuff inflation?: A comparative study

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          Abstract

          Objective:

          To compare the three common methods of endotracheal tube cuff inflation (sealing pressure, precise standard pressure or finger estimation) regarding the effective tracheal seal and the incidence of post-intubation airway complications.

          Methods:

          Seventy-five adult patients scheduled for N 2 O free general anesthesia were enrolled in this study. After induction of anesthesia, endotracheal tubes size 7.5 mm for female and 8.0 mm for male were used. Patients were randomly assigned into one of three groups. Control group ( n=25), the cuff was inflated to a pressure of 25 cm H 2O; sealing group ( n=25), the cuff was inflated to prevent air leaks at airway pressure of 20 cm H 2O and finger group ( n=25), the cuff was inflated using finger estimation. Tracheal leaks, incidence of sore throat, hoarseness and dysphagia were tested.

          Results:

          Although cuff pressure was significantly low in the sealing group compared to the control group ( P<0.001), the incidence of sore throat was similar in both groups. On the other hand, cuff pressure as well as the incidence of sore throat were significantly higher in the finger group compared to both the control and the sealing group ( P<0.001 and P=0.008). The incidence of dysphagia and hoarseness were similar in the three groups. None of the patients in the three groups developed air leak around the endotracheal tube cuff..

          Conclusions:

          In N 2O, free anesthesia sealing cuff pressure is an easy, undemanding and safe alternative to the standard technique, regarding effective sealing and low incidence of sore throat.

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          Most cited references21

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          Endotracheal tube cuff pressure in three hospitals, and the volume required to produce an appropriate cuff pressure

          Background Cuff pressure in endotracheal (ET) tubes should be in the range of 20–30 cm H2O. We tested the hypothesis that the tube cuff is inadequately inflated when manometers are not used. Methods With IRB approval, we studied 93 patients under general anesthesia with an ET tube in place in one teaching and two private hospitals. Anesthetists were blinded to study purpose. Cuff pressure in tube sizes 7.0 to 8.5 mm was evaluated 60 min after induction of general anesthesia using a manometer connected to the cuff pilot balloon. Nitrous oxide was disallowed. After deflating the cuff, we reinflated it in 0.5-ml increments until pressure was 20 cmH2O. Results Neither patient morphometrics, institution, experience of anesthesia provider, nor tube size influenced measured cuff pressure (35.3 ± 21.6 cmH2O). Only 27% of pressures were within 20–30 cmH2O; 27% exceeded 40 cmH2O. Although it varied considerably, the amount of air required to achieve a cuff pressure of 20 cmH2O was similar with each tube size. Conclusion We recommend that ET cuff pressure be set and monitored with a manometer.
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            Postoperative throat complaints after tracheal intubation.

            We have investigated the incidence of throat complaints 6-24 h after tracheal intubation in 1325 patients. Variables such as anaesthetic drug, intubation time, number of intubation attempts, gastric tube, sex and age were recorded. The incidence of sore throat was considerably lower (14.4%) compared with other reports in the literature and was significantly greater in females (17.0% vs 9.0%) and after thyroid surgery. The incidence of sore throat was not increased after multiple intubation attempts or after administration of suxamethonium or a non-depolarizing neuromuscular blocker.
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              Intracuff pressure and tracheal morbidity: influence of filling with saline during nitrous oxide anesthesia.

              Diffusion of nitrous oxide into the cuff of the endotracheal tube results in an increase in cuff pressure. Excessive endotracheal tube cuff pressure may impair tracheal mucosal perfusion and cause tracheal damage and sore throat. Filling the cuff of the endotracheal tube with saline instead of air prevents the increase in cuff pressure due to nitrous oxide diffusion. This method was used to test whether tracheal morbidity is related to excess in tracheal cuff pressure during balanced anesthesia. Fifty patients with American Society of Anesthesiologists physical status I or II were randomly allocated to two groups with endotracheal tube cuffs initially inflated to 20-30 cm H(2)O with either air (group A) or saline (group S). Anesthesia was maintained with isoflurane and nitrous oxide. At the time of extubation, a fiberoptic examination of the trachea was performed by an independent observer, and abnormalities of tracheal mucosa at the level of the cuff contact area were scored. Patients assessed their symptoms (sore throat, dysphagia, and hoarseness) at the time of discharge from the postanesthesia care unit and 24 h after extubation on a 101-point numerical rating scale. Cuff pressure increased gradually during anesthesia in group A but remained stable in group S. The incidence of sore throat was greater in group A than in group S in the postanesthesia care unit (76 vs. 20%) and 24 h after extubation (42 vs. 12%; P < 0.05). Tracheal lesions at time of extubation were seen in all patients of group A and in eight patients (32%) of group S (P < 0.05). Excess in endotracheal tube cuff pressure during balanced anesthesia due to nitrous oxide diffusion into this closed gas space causes sore throat that is related to tracheal mucosal erosion.
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                Author and article information

                Journal
                Saudi J Anaesth
                SJA
                Saudi Journal of Anaesthesia
                Medknow Publications (India )
                1658-354X
                0975-3125
                Apr-Jun 2011
                : 5
                : 2
                : 185-189
                Affiliations
                [1] Department of Anesthesia, University of Dammam, Kingdom of Saudi Arabia
                [1 ] Qatif Central Hospital, Saudi Arabia, Kingdom of Saudi Arabia
                Author notes
                Address for correspondence: Dr. Roshdi R. Al-metwalli, Department of Anesthesia, University of Dammam, King Fahad Hospital, PO Box 40081, Post Code 31952, Al-Khobar, Kingdom of Saudi Arabia. E-mail: rmetwally@ 123456hotmail.com
                Article
                SJA-5-185
                10.4103/1658-354X.82795
                3139313
                21804801
                8bdd6d5e-1306-464f-b7eb-6a6e6064265d
                Copyright: © Saudi Journal of Anaesthesia

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Categories
                Original Article

                Anesthesiology & Pain management
                airway morbidity,endotracheal tube,cuff pressure
                Anesthesiology & Pain management
                airway morbidity, endotracheal tube, cuff pressure

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