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Changes in intracuff pressure of cuffed endotracheal tubes while positioning for adenotonsillectomy in children
Author(s) -
Olsen Griffin H.,
Krishna Senthil G.,
Jatana Kris R.,
Elmaraghy Charles A.,
Ruda James M.,
Tobias Joseph D.
Publication year - 2016
Publication title -
pediatric anesthesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.704
H-Index - 82
eISSN - 1460-9592
pISSN - 1155-5645
DOI - 10.1111/pan.12873
Subject(s) - medicine , anesthesia , endotracheal intubation , tonsillectomy , intubation
Summary Background When using cuffed endotracheal tubes ( cETT s), changes in head and neck position can lead to changes in intracuff pressure. Aim The aim of this study was to assess the combined effect of neck extension, shoulder roll placement, and Crowe‐Davis retractor use during adenotonsillectomy on the intracuff pressure of cETT s in children. Methods Patients <18 years of age undergoing adenotonsillectomy under general anesthesia following the placement of a cETT were included in the study. After inflation of the cuff to seal the trachea, using the leak test, baseline intracuff pressure was recorded and then continuously monitored. After neck extension, placement of a shoulder roll, insertion of the Crow‐Davis retractor, suspension from a Mayo stand, and positioning for surgery, the intracuff pressure was recorded again. Results The study cohort included 84 patients, ranging in age from 0.9 to 17 years (5.7 ± 3.9 years). In 46 patients (54.8%), the intracuff pressure increased from baseline after positioning for adenotonsillectomy. In 12 of these patients (14.3%), the intracuff pressure was >30 cmH 2 O. The intracuff pressure decreased in 28 patients (33.3%), while no change was noted in 10 patients (11.9%). Overall, the general trend was an increase in intracuff pressure from 15.9 ± 7.8 cmH 2 O to 18.9 ± 11.6 cmH 2 O. Conclusion Both increases and decreases in the intracuff pressure may occur following positioning of the pediatric patient for adenotonsillectomy. An increase in intracuff pressure may result in a higher risk of damage to the tracheal mucosa. A decrease in the intracuff pressure can result in an air leak resulting in inadequate ventilation, increased risk of aspiration, and even predispose to airway fire if oxygen‐enriched gases are used. Continuous intracuff pressure monitoring or rechecking the intracuff pressure after positioning for adenotonsillectomy may be indicated.