Changes in endotracheal tube cuff pressure during the open and laparoscopic surgery

Abstract

Endotracheal tube is an airway catheter inserted in the trachea to assure patency of the upper airway. ETT cuff seals the trachea to facilitating positive-pressure ventilation and to prevent aspiration. The cuff pressure of an endotracheal tube depends on various patient-related factors like obesity, old age, environmental circumstances and therapeutic interventions. Physiological changes in laparoscopic surgery under general anesthesia, due to pneumoperitoneum and change in patient position can affect ETT cuff pressure. These changes in ETT cuff pressure can lead to significant peri-operative adverse outcome.To evaluate the changes in ETT cuff pressure between open and laparoscopic cholecystectomy under general anesthesia.80 ASA grade I/II patients, aged 20-50 years, undergoing laparoscopic or open cholecystectomy, under GA were included in this prospective observational study. Patients were divided in two equal sized groups (N=40) for laparoscopic and open cholecystectomy. ETT cuff pressures were recorded with ETT manometer, at 5 min intervals until extubation. Patients were followed 6 hourly, for 24 hours to record any postoperative complications.The changes in hemodynamic parameters were more in laparoscopic surgery than open surgery. Abdominal insufflation in laparoscopic surgery causes significant increase in cuff pressure due to altered thoracic compliance. Change in position, during laparoscopic surgery, also affects endotracheal tube cuff pressure.The pneumo-peritoneum and positional changes during laparoscopic surgery cause significant increase in endotracheal tube cuff pressure and thus associated with an increased incidence of post-operative complications.