Effect of Tracheal Cuff Shape on Intracuff Pressure Change During Robot-Assisted Laparoscopic Surgery: The Tapered-Shaped Cuff Tube Versus the Cylindrical-Shaped Cuff Tube.

Abstract

Although the cuff of tracheal tubes can reduce airflow leakage and prevent aspiration, excessive intracuff pressure can cause tracheal mucosal injury. Robot-assisted laparoscopic surgery (RALS) can increase intracuff pressure by the Trendelenburg position and pneumoperitoneum. The aim of our current study was to investigate the effect of tracheal cuff shape on the intracuff pressure increase by comparing two different-shaped cuffs during RALS. Ninety-eight patients undergoing RALS were allocated randomly into two groups (tapered-shaped cuff [TSC] and cylindrical-shaped cuff [CSC] groups). The intracuff pressure was measured at nine specific time points: after intubation, immediately after surgical preparation (Trendelenburg position with CO2 insufflation), at 5, 10, 15, 30, 60, and 90 minutes after surgical preparation, and at the end of surgery. Postintubation airway symptoms were measured by assessing sore throat, hoarseness, and excessive cough 1 hour after postanesthesia care unit admission. Intracuff pressure significantly increased during surgery in both groups. The trend of intracuff pressure change decreased in the TSC group compared with the CSC group, although no statistically significant changes were found (P=.450). Also, there were no statistically significant differences in the postintubation airway symptom between the two groups. The TSC tube has a tendency to decrease intracuff pressure change compared with the CSC tube during RALS. However, neither of them was beneficial in preventing intraoperative intracuff pressure increase during RALS.