Use of Microcuff^®endotracheal tubes in paediatric laparoscopic surgeries

Abstract

Background and Aims:Traditionally, uncuffed endotracheal tubes have been used in children. Cuffed tubes may be useful in special situations like laparoscopy. Microcuff® endotracheal tube is a specifically designed cuffed endotracheal tube for the paediatric airway. We studied the appropriateness of Microcuff® tube size selection, efficacy of ventilation, and complications, in children undergoing laparoscopy.Methods:In a prospective, observational study, 100 children undergoing elective laparoscopy were intubated with Microcuff® tube as per recommended size. We studied appropriateness of size selection, sealing pressure, ability to ventilate with low flow, quality of capnography and post-extubation laryngospasm or stridor.Results:Mean age of the patients was 5.44 years (range 8 months 5 days–9 years 11 months). There was no resistance for tube passage during intubation in any patient. Leak on intermittent positive pressure ventilation at airway pressure ≤20 cm H2O was present in all patients. Mean sealing pressure was 11.72 (1.9 standard deviation [SD]) cm H2 O. With the creation of pnemoperitoneum, mean intracuff pressure increased to 12.48 (3.12 SD) cm H2 O. With head low positioning, mean cuff pressure recorded was 13.32 (2.92 SD). Ventilation at low flow (mean flow 1 L/min), plateau-type capnography was noted in all patients. Mean duration of intubation was 83.50 min. Coughing at extubation occurred in 6 patients. Partial laryngospasm occurred in 4 patients, which responded to continuous positive airway pressure via face mask. Severe laryngospasm or stridor was not seen in any patient.Conclusion:Microcuff® tubes can be safely used in children if size selection recommendations are followed and cuff pressure is strictly monitored. Advantages are better airway seal and effective ventilation, permitting use of low flows.

Microcuff pediatric endotracheal tubes: Evaluation of cuff sealing pressure, fiber-optic assessment of tube tip, and cuff position by ultrasonography

“…Tube exchange was required in the remaining 12% of the patients. It has been found that the tube exchange rate was either low (2.1%) or none with the use of this age-related formula for tube size selection from the findings made by Weis et al [1] and Mhamane et al [13] The difference in this finding noted in our study can be due to the difference in patient characteristics. The four patients in whom the inappropriateness of tube selection noted was found to have height and weight below the 50 th percentile of height and weight for age.…”

Evaluation of audible leak versus pressure volume loop closure for polyvinyl chloride cuff and polyurethane microcuff in endotracheal tube inflated with air

“…Mahmoodpoor et al 7 evaluated comparison of prophylactic effects of polyurethane cylindrical or tapered cuff and PVC cuff ETTs on ventilator associated pneumonia and maintained mean cuff pressure in PVC ETT was 24.20 ± 0.47 mmHg, in polyurethane taperguard ETT was 24.10 ± 0.49 mmHg and 24.07 ± 0.48 mmHg was for polyurethane sealguard ETT ( P > 0.05). Mhamane et al 11 evaluated use of microcuff ETTs in pediatric laparoscopic surgeries. They observed mean sealing pressure was 11.72 cmH 2 O.…”

Re-intubation frequency in paediatric surgical patients : a randomised controlled trial

“…17 Moreover, the need for continuous pressure monitoring adds more obstacles to the microcuff ETT usage. 18…”