Evaluation of Endotracheal Tube Cuff Pressure in Laparoscopic Cholecystectomy and Postoperative Sore Throat.

Gajal Lakhe,Surendra Mohan Sharma

doi:10.3126/jnhrc.v15i3.18856

Gajal Lakhe, Surendra Mohan Sharma

Open Access

https://doi.org/10.3126/jnhrc.v15i3.18856

Copy DOI

Abstract

The use of nitrous oxide and carboperitoneum in laparoscopic cholecystectomy lead to increase in endotracheal tube cuff pressure. It may impair tracheal mucosal perfusion with subsequent tracheal damage. The purpose of this study was to evaluate cuff pressure and incidence of post-operative sore throat in patients undergoing laparoscopic cholecystectomy. In this prospective observational study, 128 patients aged 18-65 years of American Society of Anesthesiologist physical status I and II undergoing laparoscopic cholecystectomy were enrolled and allocated alternately into two groups, Study Group (Maintenance of anesthesia with sevoflurane 1-2%, oxygen/nitrous oxide mixture; 40/60), Control Group (Maintenance of anesthesia with sevoflurane 1-2%, oxygen/air mixture; 40/60) were analysed and comapared. Each group contained 64 patients. Aneroid manometer was used to monitor cuff pressure. Volume of air used to inflate the cuff, baseline cuff pressure, comparison of intraoperative cuff pressure and incidence of post-operative sore throat were measured. The study results demonstrated higher cuff pressure in study group at all times after the creation of carboperitoneum (p=0.00) with increased incidence of sore throat(p=0.004). Increase in endotracheal tube cuff pressure was noted with the use of nitrous oxide in laparoscopic cholecystectomy with subsequent post-operative airway complication. Monitoring of cuff pressure is simple, noninvasive and efficient way of achieving therapeutic cuff pressure of 20-30 cm of H2O and thus recommends its use.

Highlights

Carboperitoneum created at 10-15mm of Hg for laparoscopic cholecystectomy distends the peritoneal cavity and increases intra-abdominal pressure
Patients in both the groups were comparable in terms of age, gender, body mass index (BMI) and American Society of Anesthesiologist (ASA) physical status (Table 1)
In this study we noted gradual rise in endotracheal tube (ETT) cuff pressure in both the study and control group after initiation of carboperitoneum. It can be explained by the increased intraabdominal pressure (IAP) which moves the diaphragm cephalad leading to rise in intra-thoracic pressure and peak airway pressure.[3]

Summary

Introduction

Carboperitoneum created at 10-15mm of Hg for laparoscopic cholecystectomy distends the peritoneal cavity and increases intra-abdominal pressure. This pressure gets transmitted to thoracic cage which raises endotracheal tube (ETT) cuff pressure and use of nitrous oxide further add to it.[1,2] Cuff pressure of 20-30 cm of H2O is recommended which is seldom measured and palpation of pilot balloon is not the definite way of assessment. The use of nitrous oxide and carboperitoneum in laparoscopic cholecystectomy lead to increase in endotracheal tube cuff pressure. It may impair tracheal mucosal perfusion with subsequent tracheal damage. The purpose of this study was to evaluate cuff pressure and incidence of post-operative sore throat in patients undergoing laparoscopic cholecystectomy

Objectives

Methods

Results

Discussion

Conclusion