The Effect of Adjustment of Endotracheal Tube Cuff Pressure during Scarless Remote Access Endoscopic and Robotic Thyroidectomy on Laryngo-Pharyngeal Complications: Prospective Randomized and Controlled Trial

Abstract

Scarless remote access endoscopic and robotic thyroidectomy has been recently performed as a safe and feasible method. However, little is known about the laryngo-pharyngeal complications after surgery and the effect of adjusting the endotracheal tube cuff pressure during surgery on laryngo-pharyngeal complications. Patients were randomized into two groups: the control group (n = 52) and adjusted group (n = 52). The initial cuff pressure was set to 25 mmHg and then monitored without adjustment (control group) or with adjustment at approximately 25 mmHg (adjusted group) throughout surgery. The incidences and severity of postoperative sore throat (POST), hoarseness, dysphagia, and cough were recorded at 1, 6, 24, and 48 h after surgery. Cuff pressures of the control group changed significantly over time and were higher than those of the adjusted group. The incidence of POST was lower in the adjusted group at 24 h postoperatively (p = 0.035), and there was a significant difference in the severity of POST at 6 and 24 h postoperatively between the two groups. There were no differences in the incidence of hoarseness, dysphagia, and cough between the two groups, except dysphagia and cough at 6 h postoperatively. Therefore, intraoperative monitoring and adjustment of the cuff pressure can reduce the incidence of laryngo-pharyngeal complications.

Detecting Oropharyngeal and Esophageal Emptying by Submental Ultrasonography and High-Resolution Impedance Manometry: Intubated vs. Non-Intubated Video-Assisted Thoracoscopic Surgery

“…We found that intubation resulted in a longer time until effective esophageal emptying was achieved. In our opinion, the cuff pressure of the endotracheal tube may affect upper esophageal motility [ 40 , 41 ], although the cuff pressure did not exceed 30 H 2 O in any of our patients. The upper and lower portions of the esophagus influence each other [ 1 ].…”

Anterior servikal omurga cerrahisi sonrası farklı endotrakeal tüp kaf basınçlarının disfajı üzerine etkileri

“…Similarly, Inada et al showed that low endotracheal cuff pressure during hypothermic cardiopulmonary bypass was associated with low rates of tracheal mucosal ischemia 23 . On the other hand, Koo et al 24 reported that post-surgical sore throat rates were lower with lesser cuff pressures, while no such differences in the incidence of hoarseness or dysphagia were found by altering the cuff pressure during endoscopic and robotic thyroidectomy. Although no standardization of endotracheal cuff pressure measurements has been achieved yet, routine monitoring of cuff pressure is essential in preventing potential post-surgical complications 25 .…”

Effects of Endotracheal Tube with Adhesive Superficial Laryngeal Electrodes for Intraoperative Nerve Monitoring on Laryngopharyngeal Complications during Thyroidectomy

“…Postoperative hoarseness (PH), defined as a harsh or strained voice characterized by an altered vocal quality [ 20 ], was assessed during the PACU stay and on PODs 1 and 2 using a scale of 0–3 (0 = none; 1 = mild, noticed by the patient only; 2 = severe, evident to the observer; 3 = aphonia, loss of voice) [ 19 ]. The incidence of PH was defined as the number of patients with a grade of hoarseness ≥ 1.…”