Comparison of Changes in Intracuff Pressure in Endotracheal tube and Laryngeal tube
Intracuff Pressure in Endotracheal tube and Laryngeal tube
Keywords:
Laryngeal tube; ETT, Intracuff pressureAbstract
Laryngeal tube is a supraglottic device that is used effectively for managing the airway either as rescue device or device through which intubation can be done. The present study was conducted to compare the changes in intracuff pressure in the patients with endotracheal tube (ETT) and laryngeal tube (LT). Also, postoperative complications (ST and PH) caused by changes in intracuff pressure of ETT and LT.
After approval from Institutional ethics committee, the authors randomly selected 60 patients scheduled for surgery under general anesthesia (expected to last maximum 2 hours) in supine position, belonging to either sex, aged 18-60 years and who belonged to ASA physical status I or II.
After exclusions and inclusions, the patients were divided into two groups, each comprising of 30 patients. In one group the trachea was intubated with appropriate sized ETT (ETT group) and cuff was inflated to a pressure of 24-25 cm H2O; in the other group, the airway device used was LT (LT group) and cuff was inflated to a pressure of 60 cm H2O using hand held cuff inflator with pressure gauge. All patients were premedicated with Inj. Glycopyrrolate, Inj. Fentanyl and Inj. Ondansetron. Anaesthesia was induced with Inj. Propofol 2-3 mg/ kg IV. Airway device was inserted after achieving neuromuscular blockade with inj. Vecuronium 0.1 mg/kg. Anaesthesia was maintained using O2 /N2O/ Iso and Inj. Vecuronium for muscle paralysis. At the end of surgery, anaesthesia was reversed using appropriate doses of Neostigmine (50-70µg/kg) and Glycopyrrolate (10µg/kg).
Standard monitoring was instituted along with peak airway pressure and intracuff pressure of the respective airway used (measured every 15 min. starting from cuff inflation to 1 hour). Patients were also assessed for features of airway obstruction, gastric regurgitation and any evidence of airway / oropharyngeal trauma at the time of extubation (visual inspection of device for presence of blood and inspection of oral cavity for evidence of trauma); postoperatively for evidence of sore throat (ST), postoperative hoarseness (PH) and tongue numbness in PACU (2 hours) and in ward (1 day postoperatively). Appropriate statistical tests were applied.
The demographic profile was similar in both groups and all the patients in both the groups could be ventilated adequately with their respective airway device throughout the study period as indicated by end tidal CO2 measurements, SPO2 ,Peak Airway pressures and Mean airway pressures at various points of times.The hemodynamics i.e. Heart rate, Systolic Blood Pressure, Diastolic Blood Pressure, Mean Arterial Pressure, Oxygen saturation and EtCO2 were also comparable (Table 2-7).
The peak airway pressures and mean airway pressures were comparable. In both the groups 3 patients had blood on the equipment as observed after extubation. No patient had dysphagia in any of the groups and 4 patients in each group had hoarseness in immediate postoperative period. Three patients had felt sore-throat in immediate postoperative and 2 hours in ETT group and 4 patients in LT group at immediate postoperative period and 2 patients after 2 hours.
It was concluded that both ETT and LT can be effective used for controlled ventilation, during general anaesthesia; the intracuff pressure increases in both these devices to similar levels and might contribute to LPM; the incidence of PH is decreased by use of LT instead of an ETT, hence LT can be an effective alternative to ETT.
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