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REDUCING CUFF RELATED TRACHEAL MORBIDITY: A COMPARATIVE STUDY

Department of Anaesthesiology & Intensive care, Maulana Azad Medical College & Lok Nayak Hospital, Delhi 110002, INDIA

INTRODUCTION

Diffusion of Nitrous oxide into the air filled cuff of an endotracheal tube leads to an increase in cuff pressure & resultant laryngotracheal (LT) morbidity. ^1,2 Two different mediums (Saline & Anaesthetic gas mixture - Nitrous oxide in Oxygen) besides air were used for cuff inflation to determine whether LT morbidity is related to excess in tracheal cuff pressure during General Anaesthesia with nitrous oxide.

METHODS

After Institutional Research Board approval and informed consent, 62 adult patients of ASA status I & II undergoing general anaesthesia with tracheal intubation of minimum one hour duration were randomized into 3 groups. In group A, Group S & Group G; air, saline & Anesthetic gas mixture (67%N₂O in O₂) respectively were used for cuff inflation. Cuff pressure was measured following intubation & at every 15 minutes interval thereafter. At the time of extubation, fiberoptic examination was performed by an independent observer. The tracheal mucosa in the cuff contact area was scored from 0 to 3, 0 being normal mucosa and 3 being mucosal erosion or hemorrhage at more than one site. The patients were evaluated at 4 & 24 hours postoperatively for symptoms of Laryngotracheal morbidity i.e. sore throat, cough and hoarseness.

RESULTS

Cuff pressure increased throughout the procedure in group A (p<0.001) as compared to group S & group G. Tracheal mucosal lesions in the area of the cuff were more frequent in group A (57%) vs. Gp. S & Gp.G (4.7% & 15%) respectively. (P< 0.0001). Tracheal mucosal injury significantly correlated with changes in cuff pressure (p<0.001). Incidence of sore throat was greater in Gp.A (61.9%) than in Gp. S & Gp. G (14.2% & 45%) at 4 hours & 24 hrs post extubation (47% Gp. A, 9.5% Gp S, 25% Gp. G) respectively. However, no significant correlation between tracheal lesion & postoperative sore throat was found (p<0.001).

CONCLUSION

Saline & Anaesthetic gas mixture (N₂O + O₂) were found to be significantly better than air for endotracheal tube cuff inflation in avoiding increase in cuff pressure and resultant laryngo tracheal mucosal damage.

REFERENCES

1 Combes X, et al: Anaesthesiology; 95:1120–4, 2001[Medline]

2 Bennett MH, et al: Anaesth Intensive Care; 28:408–413, 2000[Medline]

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