Endotracheal Tube Cuff Pressure Research Articles

シングルルーメンチューブを用いた緊急挿管後に大量皮下気腫を生じた気管損傷の1例(A case of tracheal rupture with massive subcutaneous emphysema after emergency tracheal intubation with a single–lumen tube)

要旨 気管挿管は救急医療において日常的に行われている手技であるが，挿管後の気管損傷は稀かつ死亡リスクが高いうえ，症状発現までの時間も一定ではないため診断や原因検索に難渋する。また，発生率はダブルルーメンのほうが多く，シングルルーメンではごく僅かである。今回我々は，シングルルーメンを用いた緊急気管挿管後に大量の皮下気腫を呈したものの，良好な転帰を経た気管膜様部損傷の1例を経験したので報告する。症例は80歳代女性，明け方に呼吸困難で救急搬送された。来院時は不穏状態かつ，リザーバーマスク10L/分の高濃度酸素投与下でSpO2 86%であった。画像検査にて急性心不全による肺水腫と診断し初療室で緊急挿管を行い集中治療室管理となったが，入室時のカフ圧が高値を示していた。挿管数時間後に全身の皮下気腫を認め精査にて気管膜様部に4cmに渡る縦方向の裂傷を確認し，カフ圧損傷に伴う気管膜様部損傷と推測した。挿管後気管損傷に至る原因は患者側要因と医療側要因が複雑に絡むため原因不明な場合も多いが，双方のリスクを吟味し発症を予防するための具体的な行動指標を考察する。

Minimizing adverse effects of subjective measurement of endotracheal tube cuff pressure: Can the use of the loss of resistance technique help?

Background: Appropriate endotracheal tube cuff (ETTc) pressure estimation is essential to prevent airway complications. The pilot balloon palpation technique is the commonly used method of cuff inflation. It is however subjective thus prone to over or under estimation thus unreliable.
 Objective: To determine if the use of the passive release technique of cuff inflation would reduce commonly encountered airway complications following ETT intubation.
 Methodology: Patients scheduled for elective procedures under general anaesthesia with ETT were recruited into the study, 108 ASA I and II patients aged between 18-65 years were randomized into 2 groups with one group having their cuff inflated using the pilot balloon palpation (PBP) technique and the other by the use of a loss of resistance syringe (LOR). Airway complications were then assessed and compared between the 2 groups.
 Results: The incidences of sore throat, cough and hoarseness were significantly lower in the LOR group compared to the PBP group (35.2vs79.6%, 14.8 vs64.8% and 7.4 vs 79.6% respectively; p = 0.0001 in each case).
 Conclusion: Passive release technique using LOR was found to be less associated with post-endotracheal intubation airway complications than PBP technique

Air Versus Distilled Water Cuff Inflation using Cuffill (Digital Cuff) in Adult Patients Undergoing General Anaesthesia

Introduction: An essential part of anaesthesia is endotracheal intubation. The Endotracheal Tube (ETT) cuff pressure must not be higher than the predicted 22-30 mmHg tracheal perfusion pressure. If the ETT’s cuff is inflated with air while under nitrous oxide+oxygen anaesthesia, the cuff pressure may increase dangerously and result in ischaemia of the tracheal mucosa. Hence, distilled water as an alternative agent to air for inflation of cuffs of ETTs was used in the present study. Aim: To determine whether inflating the ETT cuff with distilled water, instead of air changes the pressure over time. To evaluate changes in cuff pressure over time, and to assess the knowledge about endotracheal cuff pressure monitoring with cuffill. Materials and Methods: The randomised clinical study was conducted from February 2022 to April 2022. The study included 50 patients undergoing elective surgery under general anaesthesia who were randomly divided into two groups. In Group-A, distilled water was used and in Group-B, air was used to inflate the cuffs of ETTs. General anaesthesia was given with nitrous oxide, oxygen and relaxant technique. The intra-cuff pressures of ETT cuffs were recorded by AG cuffill. Increase of pressures with time were recorded and analysed. Results: Mean ET cuff pressure by cuffill with air (Group-B) was 26±2.43 mmH2 O after 0 minutes of intubation. After 15 minutes of intubation mean ET cuff pressure was 31.80±3.39 mmH2 O. Mean ET cuff pressure by cuffill with distilled water (Group-A) was 25.56±2.02 mmHg after 0 minutes of intubation. After 15 minutes of intubation, mean ET cuff pressure was 28.5±2.26 cmH2 O. There was a pressure difference observed between the groups with a mean difference of 3.217, t-value of 4.743 and a p-value of 0.001. Conclusion: For the purpose of inflating the cuffs of ETTs when the patient is under general anaesthesia with the use of nitrous oxide, oxygen, and relaxant method, distilled water may be considered a more desirable agent than air.

Evaluation of the endotracheal tube cuff pressure changes during cardiac operations under cardiopulmonary bypass.

Introduction: Tracheal intubation is used for most operations under general anesthesia. Prolonged hyperinflation of the tube cuff can compromise tracheal mucosal perfusion, and low pressure of the cuff may cause some other complications. The aim of this study was the evaluation of changes in intra-cuff pressure in patients undergoing cardiac surgeries under cardiopulmonary bypass. Methods: In an observational study 120 patient's candidate to cardiac operations under cardiopulmonary bypass were enrolled. After induction of anesthesia and tracheal intubation by same tracheal tubes, tracheal tube cuff pressure was adjusted to 20-25 mm Hg (T0). Then the cuff pressure was measured at beginning of CPB (Cardio Pulmonary Bypass) (T1), at 30º hypothermia (T2) and after separation from CPB (T3). Results: The mean cuff pressure was 33.5±7.3, 28.9±5.4, 25.6±5.2 and 28.1±3.7 at T0, T1, T2 and T3 respectively. Intra- cuff pressure changed significantly during cardiopulmonary bypass. Conclusion: The mean intra-cuff pressure was decreased during hypothermic cardiopulmonary bypass. The decrease in cuff pressure may protect the tracheal mucosa against hypotensive ischemic injury in these patients.

Malawian critical care nurses' views on the implementation of an educational intervention to enhance sustained use of an evidence-based endotracheal tube cuff pressure management guideline: A survey study.

Evidence-based guidelines can assist critical care nurses in promoting best practices, including those related to endotracheal tube cuff pressure management. However, these guidelines require tailored strategies to enhance their implementation, uptake, and sustained use in practice. To evaluate Malawian critical care nurses' views on the implementation of an endotracheal tube cuff pressure management guideline to enhance sustained guideline use. An explorative-descriptive survey design was employed, using a questionnaire with closed- and open-ended questions that was distributed after implementation of an educational intervention based on an endotracheal tube cuff pressure management guideline. The questionnaire had a Cronbach's alpha score of 0.85. A total of 47 nurses working in four public and two private hospital intensive care units in Malawi participated. Quantitative findings showed that the majority of the participants (92%) indicated that the strategies used for the group that received the full intervention including both active (monitoring visits) and passive (a half-day educational session using a PowerPoint presentation, and a printed guideline and algorithm) strategies (intervention 1 group) were useful, clear and applicable and enhanced implementation of the guideline. These results were statistically significant (mean (standard deviation) 1.86 (0.84); t=6.07; p<0.0005). Qualitative data revealed three major themes related to recommendations for uptake and sustained use of the guideline in nursing practice: the guideline needs to be translated, updated, and made available to ICU staff; implementation strategies (continuous supervision and follow-up); and facilitating factors for successful implementation (education and training on guideline content, resources, and commitment to best practices). The study highlighted that although the implementation strategies used were positively received by participants, they need to be further tailored to their context to enhance guideline uptake and sustained use in practice. Further study is required to ensure that tailored implementation strategies facilitate guideline uptake and sustained use, specifically in resource-constrained contexts. The study findings can be used by nurses and academics when developing educational interventions for critical care units to enhance implementation of guidelines in this context.

Endotracheal Tube Cuff Pressure Measurement Techniques: Safety and Reliability: A Randomized Comparative Study

The purpose of this study was to examine cuff inflation techniques and corresponding pressure estimations, as well as associated complications, in patients undergoing general anaesthesia with intubation for cesarean delivery at the Tamale Teaching Hospital's obstetric unit.

ENDOTRACHEAL TUBE CUFF PRESSURE CONTROL DURING ANESTHESIA IN CANCER PATIENTS

Relevance: An endotracheal tube (ETT) cuff provides a seal and encloses the lower airway from aspiration. Normally, the pressure in the ETT cuff is in the range of 20 to 30 cm of water column. Both increased and insufficient inflation of the ETT cuff is associated with a number of complications.&#x0D; The study aimed to compare the palpation and apparatus methods of pressure control in the endotracheal tube cuff during anesthesia in cancer patients.&#x0D; Methods: A prospective observational study included 60 patients during general anesthesia in the department of anesthesiology and intensive care of KazIOR. Air was injected into the ETT cuff using a syringe, followed by palpating the ETT cuff balloon and pressure control using the IntelliCuff device (Hamilton Medical, Switzerland). The actual pressure was compared with normal values, then the air volume, actual and necessary to achieve normal pressure, was estimated.&#x0D; Results: Assessment of the pressure level by the “classic” palpation method led to errors in the pressure level in the ETT cuff in more than 50% of cases; the normal level of pressure was only in 25 patients (42%), while the measured air volume in the cuff was on average 5.9±1.9 mL, although for the average air volume to achieve a pressure of 25 mm of water column was 3.9 mL, which led to an overestimated level of pressure in the ETT cuff.&#x0D; Conclusion: Determining ETT cuff pressure by palpating the control balloon is a common practice that often results in incorrect pressure readings. At the same time, both high and low pressure in the ETT cuff is associated with complications. Using devices for measuring pressure in the ETT cuff allows you to control its level, while devices that allow prolonged monitoring of pressure in the ETT cuff have an advantage.

ENDOTRACHEAL TUBE CUFF PRESSURE CONTROL DURING ANESTHESIA&#x0D; IN CANCER PATIENTS

Relevance: An endotracheal tube (ETT) cuff provides a seal and encloses the lower airway from aspiration. Normally, the pressure in the&#x0D; ETT cuff is in the range of 20 to 30 cm of water column. Both increased and insufficient inflation of the ETT cuff is associated with a number of&#x0D; complications.&#x0D; The purpose of the research: comparison of palpation and apparatus methods of pressure control in the cuff of the endotracheal tube during&#x0D; anesthesia in cancer patients.&#x0D; Methods: A prospective observational study included 60 patients during general anesthesia in the department of anesthesiology and intensive&#x0D; care of KazIOR. Air was injected into the ETT cuff using a syringe, followed by palpation of the ETT cuff balloon and pressure control using the&#x0D; IntelliCuff device (Hamilton Medical, Switzerland). The actual pressure was compared with normal values, then the volume of air, actual and necessary to achieve normal pressure, was estimated.&#x0D; Results: assessment of the pressure level by the “classic” palpation method led to errors in the pressure level in the ETT cuff in more than 50%&#x0D; of cases; the normal level of pressure was only in 25 patients (42%), while the measured air volume in the cuff was on average 5.9±1.9 ml, although&#x0D; for the average air volume to achieve a pressure of 25 mm of water column was 3.9 ml, which led to an overestimated level of pressure in the ETT cuff.&#x0D; Conclusion: Determining ETT cuff pressure by palpation of the control balloon, while common practice, often results in incorrect pressure&#x0D; readings. At the same time, both high and low pressure in the ETT cuff are associated with the development of complications. The use of devices&#x0D; for measuring pressure in the ETT cuff allows you to control its level, while devices that allow prolonged monitoring of pressure in the ETT cuff&#x0D; have an advantage

Methods Used for Endotracheal Tube Cuff Inflation and Pressure Verification in Veterinary Medicine: A Questionnaire on Current Practice.

Endotracheal intubation is a routine procedure in veterinary anaesthesia, yet no consensus guidelines exist for endotracheal tube (ETT) cuff inflation and pressure measurement. The aim of this study was to assess current practice of ETT cuff inflation and seal verification in veterinary medicine. An online questionnaire was distributed among veterinary professionals who administer anaesthesia, comprising six demographic and twelve ETT cuff-related questions per species. N = 348 questionnaires were completed. Cuff pressure was measured by 30% of respondents in cats, 32% in dogs and 9% in both farm animals and horses. Anaesthesia diplomates were not more likely to measure cuff pressure than others, except in cats (OR: 1.8; 95% CI: 1.1-2.9). The most frequently selected recommended range of cuff pressure was 20-30 cm H2O, regardless of species, although &gt;30 cm H2O was selected significantly more often in horses compared to dogs, cats and farm animals. The preferred technique to verify cuff seal was minimal occlusive volume in dogs, cats and farm animals, whereas in horses, the preferred method was verification of normal capnogram waveform. ETT cuff pressure measurement remains uncommon in veterinary anaesthesia. The development of consensus recommendations for cuff inflation, including evidence-based target cuff pressure ranges for various species and different ETT models or materials, can help to improve practice.

Effect on Cuff Pressure of Various Endotracheal Tube Cuff Inflation Methods

Objective: To compare mean endotracheal tube cuff pressures generated using two endotracheal tube cuff inflation methods;just-Seal versus Stethoscope-Guided in patients undergoing elective surgery under general Anaesthesia.&#x0D; Study Design: Quasi-experimental study.&#x0D; Place and Duration of Study: Anesthesia Department, Combined Military Hospital, Rawalpindi Pakistan, from Jan to Jul 2021.&#x0D; Methodology: A total of 100 patients undergoing elective surgery under general endotracheal tube anaesthesia between 18–60 years of age of either gender were included. Patients were equally allocated (n=50 each) to two Groups, A (Just Seal Group) and B (Stethoscope Guided Group). In the Group-A method, the air was injected until no air leak could be heard. The pressure was measured using a “Portex cuff pressure manometer”. In the Group-B method, a stethoscope bell was placed on the thyroid lamina, and harsh breath sounds were auscultated during ventilation. Cuff was inflated till the sounds changed to smooth sounds. The pressure was measured and then noted down. &#x0D; Results: Among 100 patients, 39 % were males, and 61 % were females. The mean endotracheal cuff pressure in Group-A was 39.90±3.19 centimetres of water and 28.42±3.52 centimetres of water, with Group-B (p-value of 0.001).&#x0D; Conclusion: Post-intubation cuff pressure measured in patients undergoing elective surgery under general anaesthesia of the just seal group is higher than that in the stethoscope-guided group.&#x0D; Keywords: Cuff pressure, Stethoscope-guided, Tracheal intubation.&#x0D;

Pressure changes in tapered and cylindrical shaped cuff after extension of head and neck: A randomized controlled trial.

The proper cuff pressure of endotracheal tube (ET) plays an important role in sealing the airway and preventing airway complications during mechanical ventilation. The ET cuff shape affects the cuff pressure after positional change. To investigate cuff pressure between tapered and cylindrical cuff after extension of head and neck during nasal endotracheal intubation. In a randomized clinical trial, 52 patients were randomized to one of two groups: cylindrical cuff or Tapered cuff. Cuff pressure with 22 cmH2O was applied to patients in the neutral position. After extension of head and neck, the cuff pressure was evaluated again and readjusted to 22 cmH2O. In addition, the extent of cephalad migration of ET tip was assessed and postoperative airway complications such as sore throat, and hoarseness were measured. The cuff pressure was higher in the tapered cuff (28.7 ± 1.0 cmH2O) than in the cylindrical cuff (25.5 ± 0.8 cmH2O) after head and neck extension (P < 0.001). The extent of cephalad migration of tube tip was greater in TaperGuard ET (18.4 ± 2.2 mm) than in conventional ET (15.1 ± 1.2 mm) (P < 0.001). The incidence of postoperative airway complications was comparable between two groups. After head and neck extension, the cuff pressure and the extent of cephalad migration of ET was greater in tapered cuff than in cylindrical cuff during nasal intubation, respectively.

Endotracheal Tube Cuff Pressures in the Operating Room of a Pediatric Hospital: A Quality Improvement Initiative.

Four plan-do-study-act (PDSA) cycles were completed in the operating rooms at Nationwide Children's Hospital over 9 months to assess ways to improve the accuracy of obtaining recommended ETT cuff pressures. Control charts were used to evaluate the primary outcome measure. Preimplementation, ETT cuff pressures were out of the recommended range 76% of the time. Cuff pressures were out of the recommended range 64% of the time with the addition of the air method, 84% of the time in the tidal volume ratio cycle, and 50% of the time using the removal of air technique. The removal of air method was the most effective in achieving cuff pressures within the recommended pressure range (P < 0.001). Using quality improvement methodology, the percentage of ETT cuff pressures falling within the recommended pressure range increased using the removal of air technique. This approach is a simple and practical method that can be easily implemented in the clinical setting and would provide additional safety in the anesthetic management of pediatric patients.

The impact of esophageal device insertion on cuff pressure of endotracheal tube: a literature review and meta-analysis

The impact of intraoperative esophageal device insertion (EDI) on endotracheal tube (ET) cuff inflation pressure remains unclear. Electronic databases including Medline, Embase, Google scholar, Web of Science™ and Cochrane Central Register of Controlled Trials were searched for studies involving EDI after placement of ETs from inception to July 7, 2022. The primary outcome was risk of high cuff pressure, while the secondary outcomes were increases in cuff pressure following EDI. Difference between adults and children was investigated with subgroup analysis. There were ten eligible studies (observation study, n = 9, randomized controlled study, n = 1) involving a total of 468 participants. EDI notably increased the risk of high cuff pressure (n = 7, risk ratio: 12.82, 95% confidence interval: 4.9 to 33.52, subgroup analysis: p = 0.008). There were significant elevations in cuff pressure in adults and children both during (13.42 and 7.88 cmH2O, respectively, subgroup analysis: p = 0.15) and after (10.09 and 3.99 cmH2O, respectively, subgroup analysis: p = 0.0003) EDI. Our results revealed an over 12-fold increase in the risk of high endotracheal tube cuff pressure in patients, especially adults, receiving EDI under endotracheal anesthesia. There were significant increases in both adults and children despite a higher increase in the former after device insertion.

Laryngeal injury following endotracheal intubation: Have you considered reflux?

Laryngotracheal injury is an increasingly common complication of intubation and mechanical ventilation, with an estimated 87% of intubated and ventilated patients developing a laryngotracheal injury often preventing their rehabilitation from acute illness. Laryngotracheal injuries encompass a diverse set of pathologies including inflammation and oedema in addition to vocal cord ulceration and paralysis, granuloma, stenosis, and scarring. The existing literature has identified several factors including intubation duration, endotracheal tube size, type and cuff pressures, and technical factors including the skill and experience of the endoscopist. Despite these associations, a key aspect in the sequelae of laryngotracheal injuries is due to reflux and is not clearly related to iatrogenic and mechanical factors.Laryngopharyngeal reflux is a type of reflux that contaminates the upper aerodigestive tract. The combination of patient positioning and continuous nasogastric tube feeding act to affect the upper aerodigestive tract with acidic and non-acidic refluxate that causes direct and indirect mucosal injury impeding healing.Despite laryngopharyngeal reflux being an established and recognised causative factor of upper aerodigestive tract inflammatory pathology and laryngotracheal injury, it is very understudied in critical care. Further, there is yet to be an agreed pathway to assess, manage and prevent laryngotracheal injury in intubated and ventilated patients. The incidence of laryngopharyngeal reflux in the intubated and mechanically ventilated patient in the intensive care unit is currently unknown. Prospective studies may allow us to understand further potential mechanisms of upper aerodigestive tract injury due to laryngopharyngeal reflux and herald the development of preventative and management strategies of laryngopharyngeal reflux-mediated upper aerodigestive tract injury in critically ill patients.

Intraoperative endotracheal tube cuff pressure leak

Intraoperative endotracheal tube cuff pressure leak

Relationship between Body Position and Endotracheal Tube Cuff Pressures among Critically Ill Patients

Relationship between Body Position and Endotracheal Tube Cuff Pressures among Critically Ill Patients

A Comparative Study of Cuff Pressure Changes of Endotracheal Tube with the Use of Air Versus Nitrous Oxide in the Anaesthetic Gas Mixture During Laparoscopic Surgery.

Objective:Cuffed endotracheal tube remains the standard of care during laparoscopic surgeries. Nitrous oxide is widely used as a carrier gas in anaesthesia practice. Cuff pressure greater than 30 cm H2O impairs tracheal mucosal perfusion leading to necrosis. This study aimed to compare the endotracheal tube cuff pressure while using air versus nitrous oxide in the anaesthetic gas mixture during laparoscopic surgeries.Methods:Sixty patients aged 18-70 years undergoing laparoscopic surgery were randomized into 2 groups of 30 each. Group 1 patients received air and oxygen in the anaesthetic gas mixture and group 2 patients received nitrous oxide and oxygen. Cuff pressure changes were measured throughout the surgery and perioperative hemodynamic parameters were recorded. The incidence and severity of postoperative sore throat were also evaluated postoperatively for 24 hours.Results:The increase in cuff pressure was more in the group using nitrous oxide (40.80 ± 8.78 cm H2O) when compared to the group using air (26.93 ± 2.69 cm H2O) (P < .001). Trendelenburg position was associated with a significant increase in cuff pressure when compared to other positions. The incidence and severity of postoperative sore throat were more at 2 hours (P = .0099) and 4 hours (P = .0105) postoperatively in the group using nitrous oxide. The hemodynamic parameters were comparable between the 2 groups.Conclusion:The use of nitrous oxide in the anaesthetic gas mixture causes an increase in endotracheal tube cuff pressure and increased severity of postoperative sore throat during laparoscopic surgeries.

To study the efficacy of AG CUFFILL (Digital) compared to that of standard PORTEX cuff inflator/pressure analog gauge for the measurement of endotracheal tube cuff pressure

Endotracheal tube (ETT) is commonly used to provide positive pressure ventilation. ETT cuff pressure is maintained within a range of 20 to 30 cmH2O. High pressure affects micro-circulation and integrity of the tracheal mucosa, resulting in complications. The cuff pressure is measured by connecting a pressure gauge device to pilot balloon. Two variety devices are available; analog or digital manometers. Present study is used to study the efficacy of AG CUFFILLL (Digital) compared with standard PORTEX Cuff inflator/pressure gauge (Analog) for the measurement of ETT cuff pressure.This study was conducted after obtaining institutional ethical clearance and written informed consent.100 patients between the age of 18-70yrs who fulfilled inclusion criteria. We measured ETT cuff pressure using AG CUFFILL (Digital) and standard PORTEX Cuff inflator/pressure gauge and compared the pressure recording of the two equipment and we studied ease of use for both.Out of 100 patients between the age of 18-70yrs, 61 patients (61%) were male and 39 patients (39%) were female. Mean cuff pressure of ETT using AG CUFFILL was 36.29±6.36 cmH2O and in PORTEX was 33.97±6.16cm H2O. Mean difference in the values between the cuff pressure measured by AG CUFFILL and PORTEX was ± 2.67. Comparing the two devices, it was noticed that in 05 (5%) patients measuring ETT cuff pressure using AG CUFFILL was difficult as the values were fluctuating. Based on results, authors recommend AG CUFFILL for ETT cuff pressure measurement owing to its accuracy, non-bulky, and ease to carry.

A Rare Complication: Tracheal Laceration after Routine Intubation at the Tamale Teaching Hospital

Patients Tracheal perforation is a rare complication of endotracheal intubation that usually presents as a linear lesion in the membranous wall of the trachea. It is more prevalent in women (because they have shorter stature and a weaker pars membranosa compared to men), patients 50 years and older and patients less than 160 cm tall. Most common clinical manifestations includesubcutaneous emphysema, pneumomediastinum, pneumothorax, respiratory distress and haemoptysis. We report the case of a young male presenting with tracheal perforation after routine endotracheal intubation. This case was managed conservativelywithout complications. Possible causes for the injury include: over-inflation of the endotracheal tube cuff, intubation by an inexperienced anaesthetist or use of an inappropriately sized tube for the patient. Clinical suspicion must be followed by diagnostic confirmation, which was achieved by direct visualization of trachea rupture on bronchoscopy. We therefore encourage endotracheal tube cuff pressure monitoring during general anaesthesia and direct supervision of an inexperienced anaesthetists during critical events such as induction and intubation.

Endotracheal Tube Cuff Pressure Changes with Pneumoperitoneum and Steep Head Down Position in Patients Undergoing Robotic Urogynecological Surgeries – A Prospective Observational Study

Background: The abdominal insufflation in the laparoscopic surgery has been reported to result in an increase in endotracheal tube (ETT) cuff pressure (Pcuff). However, the effect of Trendelenburg, lithotomy and pneumoperitoneum on the ETT Pcuff in robotic urogynaecology surgeries are not well established. Aim: Analyse the changes in ETT cuff pressure during robotic urognaecological surgery. Primary Objective: 1. The changes in ETT cuff pressure after creation of pneumoperitoneum. 2. The changes in ETT cuff pressure after change in position of the patient. Secondary Objectives: 1. To correlate the changes in ETT cuff pressure with airway pressure. 2. To correlate the changes in ETT cuff pressure with BMI. Methods: Sixty patients undergoing elective robotic urogynaecology surgeries were enrolled in the study. ETT Pcuff during different time points was measured and analysed. Also, the change in ETT Pcuff was correlated with the airway pressure (Paw). Results: The difference in ETT Pcuff, before and after lithotomy, pneumoperitoneum and the Trendelenburg position were 1.1 ± 0.7 cmH2O, 4.6 ± 1.0 cmH2O and 1.8 ± 0.8 cmH2O respectively and were statistically significant (probability: P &lt; 0.05). Results obtained after reversing patient position from Trendelenburg position to supine, abdominal deflation and from lithotomy to supine respectively were -2.2 ± 1.4 cmH2O, -4.1 ± 1.0 cmH2O and -0.4 ± 0.8 cmH2O respectively (P &lt; 0.05). The Karl Pearson coefficient of correlation (r) between Pcuff and Paw after lithotomy, pneumoperitoneum, and Trendelenburg position respectively were 0.606, 0.661 and 0.309. Freidman's nonparametric repeated-measures analysis of variance (ANOVA) was used to analyze differences between related Pcuff values over different time points. Overall P value was significant (P &lt; 0.00001). Conclusion: An increase in ETT cuff pressure is seen in robotic laparoscopic surgeries after abdominal insufflation, Trendelenburg position and lithotomy position.