Comparison of Endotracheal Tube Cuff Pressure change between Supine prone and Supine – Knee Chest Position in Lumbar Disc Surgery

Arun Kumar Mandi, Priyabrata Shit, Jisnu Nayak, Sukanta Sen
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Abstract

 Background: In rare instances, massive over inflation of the cuff may lead to acute complications such as tracheal bleeding or rupture. This may be associated with post-operative complications like sore throat hoarseness of voice. The purpose of this study was to evaluate the ETT cuff pressure changes between supine to prone and supine to knee chest position in lumber disc surgery. Materials & Methods: Sixty patients, aged between 18 to 60 years of either sex, belonging to American Society of Anaesthesiology (ASA) physical status I to II undergoing elective lumbar disc surgery under general anaesthesia either in prone position or in knee-chest position were considered for this study. The patients were randomly allocated into two groups of 30 patients each. Group “p” was undergone operation in prone position and group “k” undergone operation in knee-chest position. The patients were connected to standard monitoring system such as non-invasive blood pressure (NIBP), electrocardiogram (ECG), pulse oxymeter, and capnometer. All patients were pre-medicated with inj. glycopyrrolate 0.2 mg and inj. fentanyl 2µg/kg iv 5-6 minutes before induction of anaesthesia and were pre-oxygenated with 100% oxygen for atleast 3 minutes. All the patients were induced with inj. propofol 2.5 mg/kg i.v. followed by inj. rocuronium at a dose of 1.2 mg/kg for facilitating tracheal intubation with reinforced ETT. The ETT size selected for men and women were 8.0-8.5 mm ID and 7.0- 7.5 mm ID (Mallinckrodt) respectively. Results: Group k patients showed higher cuff pressure change from 25 to 39.97cm of H2O compared to group p from 25 to 30.47 cm of H2O after change of position only. There was statistically significant different found between groups Sore throat was found significantly higher in group k compared to group p (20% vs 16.67%). Conclusion: The cuff pressure of the endotracheal tube should be monitored and managed properly after the position change from supine to prone and prone to knee chest position.
腰椎间盘手术中仰卧位与仰卧-膝胸位气管导管袖带压力变化的比较
背景:在极少数情况下,充气罩囊过度充气可能会导致气管出血或破裂等急性并发症。这可能与喉咙痛、声音嘶哑等术后并发症有关。本研究旨在评估腰椎间盘手术中从仰卧位到俯卧位以及从仰卧位到膝胸位之间 ETT 袖带压力的变化。材料和方法:本研究选取了 60 名年龄在 18 至 60 岁之间、美国麻醉学会(ASA)身体状况为 I 至 II 级、在全身麻醉下以俯卧位或膝胸位接受择期腰椎间盘手术的男女患者。患者被随机分为两组,每组 30 人。p "组采用俯卧位,"k "组采用膝胸位。患者均连接了标准监测系统,如无创血压(NIBP)、心电图(ECG)、脉搏氧饱和度仪和呼吸监测仪。所有患者均在麻醉诱导前 5-6 分钟使用甘珀酸注射液 0.2 毫克和芬太尼注射液 2 微克/千克静脉注射,并用 100% 氧气预吸氧至少 3 分钟。所有患者均使用异丙酚 2.5 毫克/千克静脉注射,然后使用剂量为 1.2 毫克/千克的罗库溴铵进行诱导,以便使用加强型 ETT 进行气管插管。男性和女性的 ETT 内径分别为 8.0-8.5 毫米和 7.0-7.5 毫米(Mallinckrodt)。结果:k 组患者的充气罩囊压从 25 厘米水柱升至 39.97 厘米水柱,而 p 组患者仅在改变体位后,充气罩囊压从 25 厘米水柱升至 30.47 厘米水柱。各组之间存在明显的统计学差异,K 组患者的咽喉痛明显高于 P 组患者(20% vs 16.67%)。结论从仰卧位到俯卧位以及从俯卧位到膝胸位的体位改变后,应适当监测和管理气管导管的充气罩囊压力。
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