Uncuffed Endotracheal Tube Experience in Pediatric Patients with Laparotomy and Laparoscopic Surgeries.

Sema Şanal Baş,Meryem Onay,Yeliz Kılıç,Gülay Erdoğan Kayhan

doi:10.1155/2020/6325293

Abstract

Aim The aim of this study is to compare endotracheal tube leak, tube selection, mechanical ventilation, and side effects in the use of uncuffed tubes in both laparoscopic and laparotomy surgeries in pediatric patients. Material and Method. Patients who underwent laparotomy (LT group) or laparoscopic (LS group) surgery between 1 and 60 months. In the selection of uncuffed tubes, it was also planned to start endotracheal intubation with the largest uncuffed tube and to start intubation with a small uncuffed tube if the tube encounters resistance and does not pass. Mechanical parameters, endotracheal tube size, tube changes, and side effects are recorded. Results A total of 102 patients, 38 females and 64 males, with a mean age of 10.9 ± 8.1 months, body weight 7.1 ± 3.7 kg, and height 67 ± 15 cm, were included. 54 patients underwent laparoscopic surgery, and 48 patients underwent laparotomy. Tube exchange was performed in a total of 18 patients. In patients who underwent tube exchange, 11 patients were intubated with a smaller ETT number and others endotracheal intubation; when the MV parameters were TVe < 8 ml/kg and ETT leak > 20%, a larger uncuffed tube was used due to PIP 30 cmH2O pressure. Patients with aspiration were not found in the LT and LS groups. There was no difference in the intergroup evaluation for postoperative side effects such as cough, laryngospasm, stridor, and aspiration. Conclusion There was no significant difference between the groups in terms of tube changes and side effects. So that we can start with the largest possible uncuffed tube to decrease ETT leak, both laparotomy and laparoscopic operations in children can be achieved with safe mechanical ventilation and target tidal volume.

Highlights

There is a widespread opinion that an uncuffed endotracheal tube (ETT) should be selected as the intubation tube in pediatric patients [1,2,3,4]
Despite disadvantages such as air leakage, environmental contamination of anesthetic gases, and aspiration, the application of an uncuffed ETT prevents trauma to the subglottic region in childhood; a lower airway is often preferred for many reasons, such as the application of resistance [1, 2, 4, 5]
We found this topic worth presenting here because we showed that the use of an uncuffed ETT in children under 5 years of age undergoing laparotomy and laparoscopic surgeries occurs smoothly and without complications

Summary

Introduction

There is a widespread opinion that an uncuffed endotracheal tube (ETT) should be selected as the intubation tube in pediatric patients [1,2,3,4] Despite disadvantages such as air leakage, environmental contamination of anesthetic gases, and aspiration, the application of an uncuffed ETT prevents trauma to the subglottic region in childhood; a lower airway is often preferred for many reasons, such as the application of resistance [1, 2, 4, 5]. There are no reports of previous studies evaluating the use of cuffed vs uncuffed ETT in pediatric patients under the age of 5 years in both laparotomy and laparoscopic surgeries The aim of this investigation is to assess whether there is a relationship between the use of perioperative mechanical ventilation management and the frequency of development of complications

Objectives

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Results

Conclusion