Assessment of cuff presure during general anesthesia in adult patients

BackgroundThe insufflation pressure of tracheal tubes is usually determined by the finger-pressure technique has low precision. The minimum leak technique is an alternative to determine whether the cuff is occluding the trachea with safe pressures (20-30cm of H2O). Our group previously described that 43% of intubated patients had excessive cuff pressures (> 30cm of H2O) when the finger-pressure technique was used.ObjectiveTo compare the finger-pressure and minimum leak techniques to achieve safe intracuff pressures in patients undergoing endotracheal intubation. Data was analyzed with t-student and lineal regression.MethodsAdult surgical patients requiring intubation were randomized in two groups in which cuff insufflation was checked by either the finger-pressure or minimum leak technique. After insufflation, the intracuff pressure was measured using an aneroid manometer. Data analysis was performed to evaluate variables that may affect performance.ResultOur study included 286 patients (216 female) with a mean age of 44.6 SE±14.9 years. The mean insufflation pressures differed significantly between groups (finger-pressure, 36.9 SE±1.9cm H2O; minimum leak, 25.3 SE±1.4cm H2O; P<0.0001). Each group had 35% of patients with pressures within safe limits. Using finger-pressure, 46% of patient had excessive pressures (>30cm H2O). Using minimum leak technique, 42% of patients had insufficient pressures (<20cm H2O). We found a consistent association between the intracuff pressure and the body mass index (r2=0.223, P<0.0001).ConclusionsFinger-pressure insufflation technique gave mean pressures 11cm H2O higher than the minimum leak technique but no replace to aneroid manometer