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

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.