Cuff pressure change during anterior cervical spine surgeries and its effects postoperatively

Abstract

Background: Anterior cervical spine surgeries carry significant morbidity postoperatively due to dysphagia, vocal cord palsy, etc. Retraction of tissues of the neck causes a rise in endotracheal cuff pressure, which can be measured using pressure transducer. This prospective and observational study was done to detect the changes in cuff pressure on retraction of soft tissues of the neck and also to assess postoperative morbidity related to the airway. Materials and Methods: Forty patients scheduled for anterior cervical spine surgery of American Society of Anesthesiologists (ASA) grades I or II were studied. Continuous cuff pressure measurement was done using a pressure transducer attached to the pilot balloon of the endotracheal tube after induction of anesthesia and endotracheal intubation. Anesthesia was maintained with 50% O 2 in N 2 O and isoflurane with intermittent doses of atracurium. Changes in cuff pressure before retraction, during retraction, and after removal of retractors were measured. No adjustment of cuff pressure was done. Postoperatively, the patients were observed for sore throat, dysphagia, and hoarseness of voice for 3 days. Video laryngoscopy was planned in case of prolonged hoarseness of voice for more than 2 days. Results: Time-adjusted mean cuff pressure before retraction was 23.10 ± 7.51 mmHg, which increased significantly during retraction (50.69 ± 17.63 mmHg). After removal of retractors, cuff pressure decreased to 37.98 ± 15.04 mmHg. Postoperatively, the average duration of sore throat was 31.65 ± 22.48 h, that of dysphagia was 34.80 ± 20.66 h, and that of hoarseness of voice was 1.96 h. Conclusion: Endotracheal cuff pressure rises significantly during neck retraction in anterior cervical spine surgeries. There is consistent postoperative morbidity related to the airway in these patients, which is self-limiting.