Effect of Adjusted Cuff Pressure of Endotracheal Tube During Thyroidectomy on Postoperative Airway Complications: Prospective, Randomized, and Controlled Trial

Ryu, Jin Suk; Han, Sun-Sook; Hwan, Sang; Lee, Jungmin; Lee, Sangchul; Choi, Eunsoo

doi:10.1007/s00268-013-1908-x

Cited by 31 publications

(49 citation statements)

References 26 publications

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“…The ETT cuff was inflated with air, and the cuff pressure was set initially at 20 cm H 2 O without air leakage. 1,2,8,26,27 The volume of air supplied to attain the cuff pressure of 20 cm H 2 O was noted. The pressure was measured during an end-expiratory hold using a calibrated cuff manometer (Portex, Smiths Medical, Germany).…”

Section: Methodsmentioning

confidence: 99%

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

Kim

Lee

Kim

et al. 2015

Can J Anesth/J Can Anesth

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Section: Methodsmentioning

confidence: 99%

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

Kim

Lee

Kim

et al. 2015

Can J Anesth/J Can Anesth

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“…Smaller tube size [5][6][7] Use of i-gel [50,[63][64][65] SAD rather than tracheal tube [121,122] Video laryngoscopy [9,10] 90°rotational insertion technique, use of introducing stylet for ProSeal LMA laryngeal mask [81][82][83][84][85] Oral rather than nasotracheal intubation [124] Limiting cuff pressure [32][33][34] Cuff pressure limitation ≤ 60 cmH 2 O [88][89][90][91][92][93]96] Cuffed rather than uncuffed tubes [125] Intravenous, topical or inhaled steroids [22][23][24][25] Topical steroids, NSAIDs, tramadol [98,101,102] Limiting tracheal tube cuff pressure [126] Topical NSAIDs [27][28][29]31] Propofol induction and maintenance [106,107] SAD cuff pressure limitation ≤ 60 cmH 2 O [130][131][132][133] Liquorice, magnesium and ketami...…”

Section: Tracheal Intubation Sads Childrenmentioning

confidence: 99%

Postoperative sore throat: a systematic review

2016

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Summary Postoperative sore throat has a reported incidence of up to 62% following general anaesthesia. In adults undergoing tracheal intubation, female sex, younger age, pre‐existing lung disease, prolonged duration of anaesthesia and the presence of a blood‐stained tracheal tube on extubation are associated with the greatest risk. Tracheal intubation without neuromuscular blockade, use of double‐lumen tubes, as well as high tracheal tube cuff pressures may also increase the risk of postoperative sore throat. The expertise of the anaesthetist performing tracheal intubation appears to have no influence on the incidence in adults, although it may in children. In adults, the i‐gel™ supraglottic airway device results in a lower incidence of postoperative sore throat. Cuffed supraglottic airway devices should be inflated sufficiently to obtain an adequate seal and intracuff pressure should be monitored. Children with respiratory tract disease are at increased risk. The use of supraglottic airway devices, oral, rather than nasal, tracheal intubation and cuffed, rather than uncuffed, tracheal tubes have benefit in reducing the incidence of postoperative sore throat in children. Limiting both tracheal tube and supraglottic airway device cuff pressure may also reduce the incidence.

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“…However, objective measurements of ETT cuff pressures to obtain and maintain recommended ranges provide a more significant reduction in these postoperative complications [6]. A review of several studies has recently introduced the idea of physical tissue damage as a precursor to postoperative airway complications [5], consistent with other recent studies regarding manometry [6,7,13,[19][20][21]. Minimizing airway cuff pressures may be the key to reducing POST.…”

Section: Introductionmentioning

confidence: 77%

“…Minimizing airway cuff pressures may be the key to reducing POST. Although the use of manometry is not commonplace, the availability of new, compact and portable devices allows easy integration into everyday practice and may help reduce the incidence of postoperative complications [8,19,20]. We therefore initiated this quality improvement project to determine whether monitoring of cuff pressures (and presumably, preventing intraoperative cuff over inflation) would translate into improved patient care and a lower incidence of complications.…”

Section: Introductionmentioning

confidence: 99%

Detrimental Effects of Filling Laryngotracheal Airways To Excessive Pressure (DEFLATE-P): a quality improvement initiative

et al. 2020

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Background: This quality improvement (QI) project was performed at a single center to determine the incidence of postoperative complications associated with use of cuffed airway devices. An educational program was then completed that involved training our anesthesia providers about complications related to excessive cuff pressure and how to utilize a quantitative cuff pressure measurement device (manometer). The impact of this educational initiative was assessed by comparing the incidence of postoperative complications associated with the use of airway devices before and after the training period. Methods: After approval by our institution's Institutional Review Board, a pre-intervention (baseline) survey was obtained from 259 adult patients after having undergone surgery with general anesthesia with the use of an endotracheal tube (ETT) or laryngeal mask airway (LMA). Survey responses were used to determine the baseline incidence of sore throat, hoarseness, and dysphagia. Once these results were obtained, education was provided to the anesthesia department members addressing the complications associated with excessive cuff pressures, appropriate cuff pressures based on manufacturer recommendations, and instructions on the use of a quantitative monitor to determine cuff pressure (manometry). Clinical care was then changed by requiring intraoperative cuff pressure monitoring throughout our institution for all surgical patients. After this educational period, 299 patients completed the same survey describing postoperative airway complications. Results: The use of manometry reduced the incidence of moderate-to-severe postoperative sore throat in the prevs. post-intervention groups (35 patients vs 31 patients, p = 0.045), moderate to severe hoarseness (30 patients vs 13, patients p = 0.0001), and moderate-to-severe dysphagia (13 patients vs 5 patients, p = 0.03). Conclusion: Caring for patients in the perioperative setting frequently entails placement of an airway device. This procedure is associated with several potential complications, including sore throat, coughing, and vocal cord damage. Our quality improvement initiative has shown that intraoperative management of intra-cuff pressure based on manometry is feasible to implement in clinical practice and can reduce postoperative airway complications.

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Effect of Adjusted Cuff Pressure of Endotracheal Tube During Thyroidectomy on Postoperative Airway Complications: Prospective, Randomized, and Controlled Trial

Abstract: Intraoperative monitoring and adjustment of the cuff pressure can reduce POST in patients undergoing thyroidectomy.

Cited by 31 publications

References 26 publications

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

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

Postoperative sore throat: a systematic review

Detrimental Effects of Filling Laryngotracheal Airways To Excessive Pressure (DEFLATE-P): a quality improvement initiative

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