Abstract
BackgroundThe abdominal insufflation and surgical positioning in the laparoscopic surgery have been reported to result in an increase of airway pressure. However, associated effects on changes of endotracheal tube cuff pressure are not well established.Methods70 patients undergoing elective laparoscopic colorectal tumor resection (head-down position, n = 38) and laparoscopic cholecystecomy (head-up position, n = 32) were enrolled and were compared to 15 patients undergoing elective open abdominal surgery. Changes of cuff and airway pressures before and after abdominal insufflation in supine position and after head-down or head-up positioning were analysed and compared.ResultsThere was no significant cuff and airway pressure changes during the first fifteen minutes in open abdominal surgery. After insufflation, the cuff pressure increased from 26 ± 3 to 32 ± 6 and 27 ± 3 to 33 ± 5 cmH2O in patients receiving laparoscopic cholecystecomy and laparoscopic colorectal tumor resection respectively (both p < 0.001). The head-down tilt further increased cuff pressure from 33 ± 5 to 35 ± 5 cmH2O (p < 0.001). There six patients undergoing colorectal tumor resection (18.8%) and eight patients undergoing cholecystecomy (21.1%) had a total increase of cuff pressure more than 10 cm H2O (18.8%). There was no significant correlation between increase of cuff pressure and either the patient's body mass index or the common range of intra-abdominal pressure (10-15 mmHg) used in laparoscopic surgery.ConclusionsAn increase of endotracheal tube cuff pressure may occur during laparoscopic surgery especially in the head-down position.
Highlights
The abdominal insufflation and surgical positioning in the laparoscopic surgery have been reported to result in an increase of airway pressure
Laparoscopic surgery is performed under general anesthesia with mechanical ventilation, and a high volume low pressure endotracheal tube with a sealing cuff pressure about 20 to 30 cmH2O is commonly used for a proper seal and avoidance of over-inflation [1,2,3,4]
Baseline characteristics of 15 patients undergoing open abdominal surgery and 70 patients undergoing laparoscopic surgery are presented in Table 1
Summary
The abdominal insufflation and surgical positioning in the laparoscopic surgery have been reported to result in an increase of airway pressure. Associated effects on changes of endotracheal tube cuff pressure are not well established. Laparoscopic surgery is performed under general anesthesia with mechanical ventilation, and a high volume low pressure endotracheal tube with a sealing cuff pressure about 20 to 30 cmH2O is commonly used for a proper seal and avoidance of over-inflation [1,2,3,4]. Abdominal CO2 insufflation elevates the intra-thoracic pressure [5,6] and adjusting patient positions by the head-up or head-down tilt results in a change in pulmonary compliance [7,8]. The correlations between airway pressure, body mass index (BMI), intra-abdominal pressure and cuff pressure change were investigated
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