Cuff Inflation Research Articles

MIMIC-BP: A curated dataset for blood pressure estimation

Blood pressure (BP) is one of the most prominent indicators of potential cardiovascular disorders. Traditionally, BP measurement relies on inflatable cuffs, which is inconvenient and limit the acquisition of such important health-related information in general population. Based on large amounts of well-collected and annotated data, deep-learning approaches present a generalization potential that arose as an alternative to enable more pervasive approaches. However, most existing work in this area currently uses datasets with limitations, such as lack of subject identification and severe data imbalance that can result in data leakage and algorithm bias. Thus, to offer a more properly curated source of information, we propose a derivative dataset composed of 380 hours of the most common biomedical signals, including arterial blood pressure, photoplethysmography, and electrocardiogram for 1,524 anonymized subjects, each having 30 segments of 30 seconds of those signals. We also validated the proposed dataset through experiments using state-of-the-art deep-learning methods, as we highlight the importance of standardized benchmarks for calibration-free blood pressure estimation scenarios.

Comparative study of endotracheal tube cuff inflation with air versus alkalinized lidocaine on hemodynamic response during extubation

Comparative study of endotracheal tube cuff inflation with air versus alkalinized lidocaine on hemodynamic response during extubation

A rare case of endotracheal tube cuff leakage with no detectable decrease in cuff pressure

BackgroundCommon causes of air leakage around an endotracheal tube include insufficient endotracheal tube cuff inflation and damage to the cuff, while damage to the pilot balloon or pilot balloon tubing is relatively rare.Case presentationA 74-year-old female with vertebral osteomyelitis was scheduled for an extreme lateral interbody fusion followed posterior fixation. A fiber-optic light was utilized as part of the surgical illuminator. A sudden decrease in tidal volume and airway pressure was noted intraoperatively. We suspected leakage around the endotracheal tube cuff; however, no decrease in cuff pressure was detected. Despite the normal cuff pressure, we decided to inject a small amount of air which led to a significant increase in the cuff pressure. Upon careful inspection of the endotracheal tube, we discovered that the pilot balloon tubing was damaged as a result of thermal energy emitted by the fiber-optic light, which had ignited the surgical drape. The pilot balloon tubing was partially severed in which the section proximal to the endotracheal tube cuff was burned and punctured, causing the cuff leak. Meanwhile, the section proximal to the pilot balloon had melted and occluded the lumen, resulting in a falsely normal cuff pressure reading followed by an elevated cuff pressure when a small amount of air was injected into the pilot balloon during troubleshooting. Appropriate ventilation was resumed after extubation and re-intubation with a new endotracheal tube.ConclusionsWe experienced an endotracheal tube cuff leakage caused by a damaged pilot balloon tubing due to thermal energy of the fiber-optic light. Our case report emphasizes the importance of suspecting damage to the endotracheal tube cuff and inflation system despite a normal cuff pressure reading, given that the measurement may be falsely elevated depending on the specific location of the damage. In addition, all operating personnel should be familiarized with safety warnings and cautions related to handling.

Single and consecutive 10-day remote ischemic preconditioning modify physical performance, post-exercise exerkine levels, and inflammation.

Remote ischemic preconditioning (RIPC) is a method of protection against induced ischemia reperfusion injury, and an increasing number of studies showed some of its inconclusive ergogenic effects in sports. RIPC involves short cycles of cuff inflation followed by its deflation which may affect many body systems. While most of the studies focus on single RIPC effects, there is insufficient data regarding training-like repeated RIPC interventions. Thus, in this study, we analyzed the effect of a single- and consecutive 10-day RIPC procedure on a single leg, focusing on the exerkine levels and changes in inflammation markers following the Wingate Anaerobic Test (WAnT). Two single-blinded, sham-controlled protocols were designed to evaluate the 1) single (crossover study) and 2) consecutive 10-day (parallel study) RIPC effects on the WAnT performance and exercise-induced lactate, glucose, exerkine, and inflammation markers (BDNF; IL-6; IL-10; IL-15; LIF; oncostatin M). In each protocol, 37 physically active men (19.98 ± 1.17 years) were randomly assigned into two groups according to a particular study design. An increase in participants' mean (4.81%, p < 0.05) and peak power (6.25%, p < 0.05) during the WAnT was observed only after the consecutive 10-day RIPC. Similarly, a significant 15.5% (p < 0.05) decrease in the IL-6 concentration 120 min after the WAnT was observed only in the consecutive 10-day RIPC protocol, as well as a 12.2% (p < 0.01) increase in oncostatin M 60 min after the WAnT. The results demonstrate the efficacy of the consecutive 10-day RIPC procedure in modulating exercise performance and post-exercise inflammation markers.

Effects of Blood Flow Restriction Training on Muscle Strength and Hypertrophy in Untrained Males: A Systematic Review and Meta-Analysis Based on a Comparison with High-Load Resistance Training.

This meta-analysis examined the efficacy of low-load resistance training with blood flow restriction (LL-BFR) versus high-load resistance training (HL-RT) on muscle strength and hypertrophy, exploring factors affecting outcomes. We searched Embase, CNKI, Wanfang, PubMed, Ovid Medline, ProQuest, Cochrane Library, Embase, and Scopus from inception to July 2024. After assessing the risk of bias using the Cochrane tool, a meta-analysis was conducted to calculate the overall effect size. Subgroup analyses were performed to explore the impact of different modulating factors on training effects. LL-BFR was found to be inferior to HL-RT with regard to muscle strength gains (SMD = -0.33, 95% CI: -0.49 to -0.18, p < 0.0001). However, subgroup analyses revealed that LL-BFR achieved muscle strength gains comparable to HL-RT under individualized pressure (SMD = -0.07, p = 0.56), intermittent cuff inflation (SMD = -0.07, p = 0.65), and a higher number of training sessions (SMD = -0.12, p = 0.30). No significant difference in muscle mass gains was observed between LL-BFR and HL-RT (SMD = 0.01, p = 0.94), and this conclusion remained consistent after controlling for modulating variables. HL-RT is superior to LL-BFR in enhancing muscle strength gains. Nevertheless, under appropriate conditions, including individualized pressure prescription, intermittent cuff inflation, and a higher number of training sessions, LL-BFR can achieve muscle strength gains comparable to HL-RT, emphasizing the importance of tailored training programs. Both methods exhibit similar effects on muscle mass gains, indicating that LL-BFR serves as an effective alternative for individuals who cannot perform HL-RT because of physical limitations or injury concerns.

Kaf İçi ve Dışına Lidokain Uygulamasının Ekstübasyon Sonrası Görülen Kardiyovasküler ve Solunum Sistemi Yanıtlarına Etkileri

Objective: In our investigation, we aimed to assess the efficacy of employing lidocaine spray application around endotracheal tube cuff (ETTC) prior to intubation, alongside and the use of intracuff lidocaine application following intubation. Our primary objective encompassed an examination of the resultant effects on the cardiovascular and respiratory systems leading up to the extubation phase. Methods: Two hundred patients scheduled for gynecologic operations, with an ASA physical status of I or II and aged between 18 and 65 years, undergoing general anesthesia lasting over one hour, were recruited for the study. Patients were allocated into four groups. Group I involved the inflation of the endotracheal tube cuff with air following intubation. In Group II, 10% lidocaine was sprayed around the ETTC prior to intubation. Group III entailed the inflation of the ETTC with 2% lidocaine after intubation. Lastly, Group IV received both the pre-intubation application of 10% lidocaine spray around the ETTC and the inflation of the cuff with 2% lidocaine following intubation. Cardiovascular parameters in the early post-extubation period and occurrences of postoperative sore throat, cough, and hoarseness up to 48 hours post-operation were documented for analysis. Results: Increases were observed at cardiovasvular system parameters after extubation in all groups continued for 5 or 15 minutes. Postoperative data for sore throat, cough and hoarseness were smilar in all groups. Conclusion: The study revealed that the administration of 10% lidocaine spray around the ETTC, as well as the use of 2% lidocaine within the cuff alone or in combination, did not result in a reduction of cardiovascular system responses during the early post-extubation period. However, these interventions did lead to a decrease in postoperative respiratory system side effects, albeit not providing complete prevention of such occurrences. Keywords: Lidocaine, endotracheal tube cuff, extubation, hemodynamic, pulmonary

Automated cardiac arrest DETECTion incorporated into a wristband: validation of a photoplethysmography algorithm in patients with spontaneous and induced cardiac arrest

Abstract Background Although survival from out-of-hospital cardiac arrest (OHCA) has improved, this does not apply to unwitnessed cases, as the arrest is often recognized too late. Automated cardiac arrest detection and alarming using a wristband is a promising technology to facilitate early assistance after cardiac arrest in a home setting. In the DETECT-1 study, a photoplethysmography(PPG) algorithm for circulatory arrest detection has been developed in patients with induced circulatory arrest. Purpose To assess the performance of the developed PPG algorithm for circulatory arrest detection in: 1) patients with spontaneous cardiac arrest; 2) subjects with induced circulatory arrest using blood pressure cuff inflation. Methods We selected patients with episodes of spontaneous cardiac arrest who participated in the DETECT-1 study and patients/healthy subjects with short-lasting induced circulatory arrest using blood pressure cuff inflations from the DETECT-1 and DETECT-2 studies. The DETECT-1 study included patients who underwent transcatheter aortic valve implantation (TAVI), subcutaneous ICD implantation, or ventricular tachycardia ablation. Included patients wore the PPG-wristband during the procedure. Continuous ECG and invasive blood pressure data were collected as reference standard. The DETECT-2 study included healthy volunteers who wore the PPG-wristband during physical exercise. Sensitivity for spontaneous and induced circulatory arrest and false positive alarms were assessed using the previously developed algorithm for circulatory arrest detection. All episodes were analyzed as individual events. Results A total of 39 individuals were included; nine patients with spontaneous cardiac arrests during TAVI and 20 subjects with 116 induced circulatory arrests. Of the patients with spontaneous cardiac arrest, two had ventricular fibrillation, five had pulseless electrical activity (figure), and two had asystole. Eight out of nine cardiac arrest events were detected by the circulatory arrest detection algorithm (sensitivity 89% [95% CI 51-99%]). Of the subjects with induced circulatory arrests, the PPG algorithm detected 114 induced circulatory arrests, yielding a sensitivity of 98% (95% CI 93-100%). In the entire group, there were no false positive alarms during 60 recording hours. Conclusions Automated cardiac arrest detection using a PPG-wristband is feasible with excellent sensitivity for both spontaneous and induced circulatory arrest. False positive alarms were absent in this controlled setting. Further study is warranted to assess algorithm performance in a larger sample of spontaneous cardiac arrests, and false positive alarms during daily life use. If available, automated cardiac arrest detection and alarming has the potential to markedly increase survival from OHCA in a home setting.Episode of spontaneous cardiac arrest

The Effect of Exercises with Blood Flow Restriction in the Limbs on the Development of Muscle Strength and Hypertrophy: A Pilot Study

Weight training with regulated blood flow in the limbs is characterized by low load intensity ranging from 30-50% of the one repetition maximum. The aim of the study was to assess the effect of weight training with regulated blood flow in the limbs on changes in muscle strength and hypertrophy. The research sample consisted of 5 participants aged 26.40±7.16 years who performed 10-week intervention program. The weekly microcycle consisted of three training sessions, which intensity was regulated by inflatable cuffs placed on proximal parts of upper and lower limbs. Body composition was assessed with InBody 720. Muscle strength of knee and elbow flexors and extensors was assessed with Cybex HUMAC NORM isokinetic dynamometer at four speeds ranging from 60-240°·s-1, supplemented by front squat and bench press with emphasis on speed during the concentric phase of the movement. The results showed an increase in knee flexor muscle strength that was not statistically significant. The present pilot-study points to the need for further verification of methods how to use regulated blood flow in training related to muscle strength and hypertrophy.

Optimizing patient safety: Unveiling the significance of cuff pressure in anaesthesia

BackgroundInadequate pressure in the endotracheal tube (ETT) cuff can lead to compromised ventilation or airway injury. Accurate assessment of ETT cuff pressure is essential and should be performed using a manometer, with an optimal target range of 20–30 cmH2O. AimIn this study, we aimed to audit ETT cuff pressures in the operating theatre of our institution, utilizing a manometer from VBM Medizintechnik GmbH™. MethodsFollowing approval from the ethics committee, we conducted an audit from January 2023 to November 2023. A convenience sample was utilized, including adult patients who were intubated in our operating rooms (ORs) during either the morning or afternoon shifts at the time of the audit. ResultsA total of 49 patients were evaluated. Our findings revealed that 78 % of the patients had cuff pressures outside the recommended target range, with recorded pressures ranging from 18 cmH2O to 120 cmH2O, and a mean pressure of 63 cmH2O. Nitrous oxide was not used in any of the cases. Cuff inflation was performed using different syringe volumes: a 5 mL syringe was used in one case, a 10 mL syringe in 20 cases, and a 20 mL syringe in 28 cases, with a mean inflation volume of 9 mL. Statistical analysis indicated no significant difference in ETT cuff pressure related to the type of syringe used or the size of the endotracheal tube. Additionally, no correlation was found between the volume of air used for cuff inflation and the resulting ETT cuff pressure. ConclusionOur audit revealed that only 22 % of the patients had cuff pressures within the recommended limits, highlighting a significant need for increased awareness and education. As maintaining appropriate cuff pressure is a standard of care, systematic implementation of reliable cuff pressure monitoring is strongly recommended.

Alkalized lidocaine in endotracheal tube cuff inflation in patients undergoing thyroidectomy surgery: a clinical trial.

The aim of the study was to compare the postoperative effects of endotracheal tube cuff inflation with alkalized lidocaine in patients undergoing thyroidectomy surgery. This is a randomized, double-blind clinical trial between August 2020 and August 2022 at the Hospital São Domingos, São Luís, Maranhão, Brazil. Patients over 18 years who underwent thyroidectomy of both sexes, American Society of Anesthesiologists (ASA) I or ASA II, were included. Patients with difficult orotracheal intubation, smoking, cuff rupture during orotracheal intubation, heart, lung, or neuropathies, previous surgery of the larynx or trachea, with risk of aspiration of gastric contents, or with the need to use a nasogastric tube were excluded. Patients were randomly selected and divided into the control group, whose cuff was filled with 0.9% saline solution, and the alkalinized lidocaine group, where the cuff was filled with 2% lidocaine and 8.4% sodium bicarbonate. The control group had higher systolic blood pressure [137 (94-183) mmHg] medians after extubation than the alkalinized lidocaine group [127 (82-189) mmHg] (p=0.03). The same was observed in heart rate values [control group: 86 (62-120); alkalinized lidocaine group: 80 (53-120)] (p=0.034). The alkalinized lidocaine group showed a significant increase in the ability to sustain phonation in the 24 h postoperatively, from 82.0 to 98.0% (p=0.031). There was no protective effect of the use of alkalinized lidocaine on the sensation of swallowing and complaints after thyroidectomy surgery. There was a significant improvement in hemodynamic response in the intervention group after extubation.

From Concept to Cure: The Life and Legacy of Scipione Riva-Rocci.

The evolution of cardiovascular diagnostics has been profoundly influenced by the invention of the sphygmomanometer, a groundbreaking tool that transformed the measurement of blood pressure from an imprecise and invasive process into a routine and reliable clinical practice. Scipione Riva-Rocci, an Italian physician, developed the mercury sphygmomanometer in 1896, revolutionizing the way blood pressure was measured and managed. This simple yet innovative device, comprising an inflatable cuff, a mercury column manometer, and a stethoscope, provided the first accurate, noninvasive method for measuring blood pressure. The introduction of the Riva-Rocci sphygmomanometer not only enhanced the ability to diagnose and treat hypertension but also laid the foundation for modern cardiovascular medicine. The widespread adoption of this device has had a lasting impact on patient care, enabling early detection and management of cardiovascular diseases, thus significantly reducing morbidity and mortality. This review examines the design, development, and enduring legacy of Riva-Rocci's sphygmomanometer, highlighting its pivotal role in the history of medical innovation and its continued relevance in contemporary clinical practice.

Induced blood flow oscillations at 0.1 Hz protects oxygenation of severely ischemic tissue in humans.

Generating 10-s (∼0.1 Hz) fluctuations or "oscillations" in arterial pressure and blood flow blunts reductions in cerebral tissue oxygenation in response to 15%-20% reductions in cerebral blood flow. To examine the effect of 0.1 Hz hemodynamic oscillations on tissue oxygenation during severe ischemia, we developed a partial limb ischemia protocol targeting a 70%-80% reduction in blood flow. We hypothesized that 0.1 Hz hemodynamic oscillations would attenuate reductions in tissue oxygenation during severe ischemia. Thirteen healthy humans (6 M and 7 F; 27.3 ± 4.2 yr) completed two experimental protocols separated by ≥48 h. In both conditions, an upper arm cuff was used to decrease brachial artery (BA) blood velocity by ∼70%-80% from baseline. In the oscillation condition (0.1 Hz), 0.1 Hz hemodynamic oscillations were induced by intermittently inflating and deflating bilateral thigh cuffs every 5 s during forearm ischemia. In the control condition (0 Hz), the thigh cuffs were inactive. BA blood flow, forearm tissue oxygenation (SmO2), and arterial pressure were measured continuously. The initial reduction in BA blood velocity was tightly matched between protocols (0 Hz: -76.9 ± 7.9% vs. 0.1 Hz: -75.5 ± 7.4%, P = 0.49). Although 0.1 Hz oscillations during forearm ischemia had no effect on the reduction in BA velocity (0 Hz: -73.0 ± 9.9% vs. 0.1 Hz: -73.3 ± 8.2%, P = 0.91), the reduction in SmO2 was attenuated (0 Hz: -35.7 ± 8.6% vs. 0.1 Hz: -27.2 ± 8.9%, P = 0.01). These data provide further evidence for the use of 0.1 Hz hemodynamic oscillations as a potential therapeutic intervention for conditions associated with severe tissue ischemia (e.g., hemorrhage and stroke).NEW & NOTEWORTHY We investigated the effects of induced 10-s (0.1 Hz) oscillations in blood flow on forearm tissue oxygenation during severe ischemia. Intermittent inflation of bilateral thigh cuffs was used as a clinically applicable method to drive blood flow oscillations. In support of our hypothesis, 0.1 Hz oscillations in blood flow blunted reductions in forearm tissue oxygenation. These results further support the potential use of oscillatory hemodynamics as a therapeutic intervention for ischemic conditions.

The Effect of Low-Intensity Interval Exercise with Blood Flow Restriction on Plasma Cardiac Troponin: A Cross-Design Trial.

Low-intensity training with blood flow restriction (BFR) training could induce endurance adaptations, its impact on myocardial markers is still unclear compared to training without BFR. Consequently, the influence of low-intensity interval exercise with and without BFR and high-intensity interval exercise (HIIE) on cardiac troponin was determined in this study. Twelve physically active males between 18 and 26 years volunteered as participants. The participants completed 3 exercise tests in random order, which included 40% VO2max low-intensity cycling without BFR (group L), 40% VO2max low-intensity cycling with BFR set at 60% limb occlusion pressure (LOP) (group B), and 80% VO2max high-intensity cycling without BFR (group H). Participant muscle oxygen, blood flow, oxygen uptake, heart rate (HR), perceived exertion (RPE) rating, and pain levels were determined before and after exercise, after cuff inflation, and pre- and post-each exercise. Moreover, before each protocol, immediately after the exercises, and 3-4 hours after each exercise, elbow vein blood samples were collected to evaluate lactate (LA) and high-sensitivity cardiac troponin T (cTnT). Increased LA was recorded after exercise by the individuals in group H, which was more significant than in group B. Moreover, group B documented a more significant LA increment than group L (P < .05). The peak cTnT of groups B and H after exercise was significantly higher (P < .05). Furthermore, the increase was more significant than the values recorded by group L (P < .05). The present study demonstrated that low-intensity interval exercise combined with BFR could cause cTnT elevations compared to training without BFR. The increase was similar to HIIE protocols.

Blood flow restriction training (BFRT) in patients before and after total knee arthroplasty

In healthy individuals, blood flow restriction training (BFRT) has shown positive effects on muscle mass, strength, fatigue resistance, as well as tendon and bone metabolism. BFRT reduces blood flow in the extremities using inflatable cuffs, creating local muscular hypoxia, which produces an anabolic metabolic environment. This promotes significant muscular and cardiovascular adaptations even at low mechanical training loads. BFRT also shows promising initial results in pre- and postoperative applications for knee endoprostheses (KTEP). Both preoperative and postoperative BFRT can improve muscle strength and joint function, accelerate recovery, and alleviate pain. Although the method is generally safe, potential risks such as discomfort and rare side effects must be considered. Clear application protocols are still lacking, necessitating further research and individualized programs to achieve optimal training effects. BFRT thus offers an innovative way to effectively rehabilitate patients despite their low load tolerance.

Studying the Optimal Air Volume Needed for Inflating the Cuff of an Endotrecheal Tube: A Clinical Observational Study

Abstract: An endotracheal tube (ETT) is a polyvinyl chloride (PVC) flexible plastic tube, this tube is placed into the trachea through the mouth or nose. During the course of general anaesthesia or when a patient is unable to breath by him / herself the endotracheal tube is placed for the maintenance of breathing when it is necessary to sedate the patient, and airway protection is thus lost. Endotracheal tube is used for the protection of airway from any foreign body so that air can pass into and out of the lungs by which it can maintain the airway. This tube needs a special consideration with regards to cuff inflation for creating a seal in between trachea and endotracheal tube for preventing chances of aspiration and leakage of air. Therefore, we are conducting this study to find the optimal air volume needed to inflate the cuff of ETT and minimise the complications associated with over and underinflation of cuff. The conclusion of our study shows that There was a tendency to overinflate the ETT cuff, resulting in high intracuff pressure. The estimated optimal air volume needed for inflating the ETT cuff was about 6.05 ml for men and 5.45 ml for women.

Limb Position Influences Peripheral Arterial Stiffness Reduction with Reactive Hyperemia

The mechanism behind the acute reduction in peripheral arterial stiffness with reactive hyperemia is presumed to be flow-mediated; however, this has not been clearly demonstrated. We hypothesized that a larger reactive hyperemia magnitude would result in a greater reduction in peripheral arterial stiffness. Fourteen healthy young adults (5 females, 25 ± 5 yrs, mean ± SD) underwent reactive hyperemia with a rapid-release cuff on the upper arm inflated to 220 mmHg for 5 min: once with the arm positioned ~ 50ο above heart level and once with the arm positioned ~ 50ο below heart level. Brachial-radial pulse wave velocity (PWV) was measured with tonometers over brachial and radial arteries before cuff inflation and at 5, 15, and 30 min after release. Brachial blood flow was monitored with doppler ultrasound. At 5 min after reactive hyperemia, both the absolute (2.31 ± 1.22 vs 1.19 ± 1.19 m/sec, p = 0.007) and relative (24% vs 15%; p = 0.043) changes in brachial to radial PWV were greater with the arm below the heart compared to above the heart. The peak brachial blood flow was higher when the arm was below the heart compared to above the heart (477 ±\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\pm$$\\end{document} 145 vs 369 ±\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\pm$$\\end{document} 137 ml/min; p < 0.001). Reactive hyperemia acutely reduced peripheral arterial stiffness above and below heart level, with a greater decrease observed when the arm was positioned below the heart. These results demonstrate the contribution of conduit artery blood flow to the reduction of peripheral arterial stiffness after reactive hyperemia.

Effect of cuff inflation with lidocaine, saline, and air on tracheal tube cuff pressure during laparoscopic resection of colorectal neoplasms: a randomized clinical trial

BackgroundTracheal tube cuff pressure will increase after pneumoperitoneum when the cuff is inflated with air, high pressure can cause tracheal mucosal damage. This prospective trial aimed to assess if inflating with normal saline or lidocaine can prevent increase of tracheal tube cuff pressure and tracheal mucosal damage in laparoscopic surgeries with general anesthesia. Whether changes of tracheal tube cuff transverse diameter (CD) can predict changes of tracheal tube cuff pressure.MethodsNinety patients scheduled for laparoscopic resection of colorectal neoplasms under general anesthesia were randomly assigned to groups air (A), saline (S) or lidocaine (L). Endotracheal tube cuff was inflated with room-temperature air in group A (n = 30), normal saline in group S (n = 30), 2% lidocaine hydrochloride injection in group L (n = 30). After intubation, tracheal tube cuff pressure was monitored by a calibrated pressure transducers, cuff pressure was adjusted to 25 cmH2O (T0.5). Tracheal tube cuff pressure at 15 min after pneumoperitoneum (T1) and 15 min after exsufflation (T2) were accessed. CD were measured by ultrasound at T0.5 and T1, the ability of ΔCD (T1-0.5) to predict cuff pressure was accessed. Tracheal mucous injury at the end of surgery were also recorded.ResultsTracheal tube cuff pressure had no significant difference among the three groups at T1 and T2. ΔCD had prediction value (AUC: 0.92 [95% CI: 0.81–1.02]; sensitivity: 0.99; specificity: 0.82) for cuff pressure. Tracheal mucous injury at the end of surgery were 0 (0, 1.0) in group A, 0 (0, 1.0) in group S, 0 (0, 0) in group L (p = 0.02, group L was lower than group A and S, p = 0.03 and p = 0.04).ConclusionsCompared to inflation with air, normal saline and 2% lidocaine cannot ameliorate the increase of tracheal tube cuff pressure during the pneumoperitoneum period under general anesthesia, but lidocaine can decrease postoperative tracheal mucosa injury. ΔCD measured by ultrasound is a predictor for changes of tracheal tube cuff pressure.Trial registrationChinese Clinical Trial Registry, identifier: ChiCTR2100054089, Date: 08/12/2021.

Comparative Efficacy of Intracuff 1% and 2% Alkalinized Lignocaine with Saline on Endotracheal Tube-Induced Hemodynamic Changes and Emergence Phenomena in Neurosurgical Patients.

Introduction Extubation is associated with hemodynamic changes and emergence phenomena leading to cough, sore throat, dysphonia, and dysphagia in the postoperative period. The aim of our study was to compare intracuff 2% alkalinized lignocaine with 1% alkalinized lignocaine and saline in reducing endotracheal tube induced emergence phenomena and haemodynamic changes at extubation in neurosurgical patients. Materials and Methods In this randomized controlled study, 90 adult patients of either sex, scheduled to undergo neurosurgical procedures were randomly divided into three groups of 30 each to receive either 1% alkalinized lignocaine (AL1), 2% alkalinized lignocaine (AL2), or saline as cuff inflation media. Intracuff pressures and haemodynamic variables were noted intraoperatively and during emergence. The presence of postextubation cough, sore throat, dysphonia, and dysphagia were monitored until 24 hours postoperatively. Data were analyzed using Chi-square test and ANOVA. A p -value of less than 0.05 was considered significant. Results The intracuff pressures were significantly less with alkalinized lignocaine as compared to saline, after 3 hours of induction. Post extubation, hemodynamic parameters and incidence of coughing and bucking at extubation were significantly less in Groups AL1 ( p = 0.024) and AL2 ( p = 0.02) as compared to saline. On assessment of laryngotracheal morbidity, the incidence of coughing was found to be significantly less with 2% alkalinized lignocaine as compared to saline ( p = 0.021) at 1 hour after extubation. Sore throat was significantly less in Groups AL1 and AL2 as compared with saline at 1 hour ( p = 0.008, 0.002 respectively) and 8 hours ( p = 0.01 in both groups), and in Group AL2 versus saline at 24 hours ( p = 0.044) after extubation. The incidence of dysphonia was significantly less in Groups AL1 and AL2 as compared with saline at 1 hour ( p = 0.016, p = 0.002) and 24 hours ( p = 0.012 in both groups) and in Group AL2 versus saline at 8 hours (p = 0.03) postoperatively. No significant differences were noted between 1% alkalinized lignocaine and 2% alkalinized lignocaine. Conclusion Intracuff alkalinized lignocaine 1% and 2% were significantly better than saline in reducing coughing and bucking at extubation, post extubation haemodynamic changes and incidence of postoperative cough, sore throat, and dysphonia.

In silico assessment of the reliability and performance of artificial sphincter for urinary incontinence.

The standard artificial urinary sphincter (AUS) is an implantable device for the treatment of urinary incontinence by applying a pressure loading around the urethra through an inflatable cuff, often inducing no-physiological stimulation up to tissue degenerative phenomena. A novel in silico approach is proposed to fill the gap of the traditional procedures by providing tools to quantitatively assess AUS reliability and performance based on AUS-urethra interaction. The approach requires the development of 3D numerical models of AUS and urethra, and experimental investigations to define their mechanical behaviors. Computational analyses are performed to simulate the urethral lumen occlusion by AUS inflation under different pressures, and the lumen opening by applying an intraluminal pressure progressively increased under the AUS action (Abaqus Explicit solver). The AUS reliability is evaluated in terms of tissue stimulation by the mechanical fields potentially responsible for vasoconstriction and tissue damage, while the performance by the intraluminal pressure that causes the lumen opening for a specific occlusive pressure, showing the maximum urethral pressure for which continence is guaranteed. The present study implemented the procedure considering the gold standard AMS 800 and a novel patented AUS. Results provided the comparison between two sphincteric devices and the evaluation of the influence of different building materials and geometrical features on the AUS functionality. The approach was developed for the AUS, but it could be adapted also to artificial sphincters for the treatment of other anatomical dysfunctions, widening the analyzable device configurations and reducing experimental and ethical efforts.

Endotracheal tube cuff position in relationship to the walls of the trachea: A retrospective computed tomography-based analysis.

The use of cuffed endotracheal tubes (ETTs) has become the standard of care in pediatric practice. The rationale for the use of a cuffed ETT is to minimize pressure around the cricoid while providing an effective airway seal. However, safe care requires that the cuff lie distal to the cricoid ring following endotracheal intubation. The current study demonstrates the capability of computed tomography (CT) imaging in identifying the position of the cuff of the ETT in intubated patients. The study included patients ranging in age from 1 month to 10 years who underwent neck and chest CT imaging that required general anesthesia and endotracheal intubation. The location of the ETT and of the cuff within the airway was determined from axial CT images at three levels (proximal, middle, and distal). Anatomical orientations were tabulated, and percent chances of each orientation were determined for the ETT and the cuff. The study cohort included 42 patients ranging in age from 1 to 114 months. An ETT with a polyvinylchloride cuff was used in 24 patients, and an ETT with a polyurethane cuff was used in 18 patients. The ETT was located near the posterior wall of the trachea in approximately 24-38% of patients, being most likely to be centrally located at the proximal end and at its mid-portion. The middle part of the cuff was most likely to be positioned in the mid-portion of the trachea but tended to skew anteriorly at both the proximal and distal ends. This is the first study using CT imaging to identify the uniformity of cuff inflation within the trachea in children. With commonly used cuffed ETTs, cuff inflation and the final position of ETT cuff within the tracheal lumen were not uniform. Future investigations are needed to determine the reasons for this asymmetry and its clinical implications.