LUMBAR DİSK HERNİSİ OPERASYONLARININ ENDOTRAKEAL KAF BASINCINA VE TRAKEAL MORBİDİTEYE ETKİSİ

Year 2023, Volume: 3 Issue: 1, 40 - 45, 29.04.2023

Yusuf İpek , Zeynep Baysal , Enes Çelik , Hakan Akelma

Abstract

Amaç: Endotrakeal tüplerin kafları yüksek basınçla şişirildiğinde ciddi anlamda morbiditeler ile karşılaşılır. Çalışmamızın amacı farklı pozisyonlarda değişebilen endotrakeal tüp kaf basıncının operasyon süresince değerlerini takip edilmesi ve trakeal morbiditeye etkilerinin araştırılmasıdır.
Materyal ve method: Prospektif gözlemsel çalışma.Çalışmaya endotrakeal entübasyon ile genel anestezi uygulanan yaşları; 18-80 arasında olan, ASA 1-2 grubunda, Mallampati sınıf 1-2 ye giren rastgele seçilmiş 60 hasta dahil edildi. Lomber disk hernisi operasyonu olan 30 hasta prone pozisyonunda grup 1, alt veya üst ekstremite cerrahisi olan 30 hasta supine pozisyonunda grup 2 olmak üzere 2 gruba ayrıldı. Tüm hastalara standart genel anestezi uygulandı. Her iki gruptaki hastalar supine pozisyonunda entübe edildikten sonra endotrakeal kaf manometresi ile 28-30 cmH2O arasında olacak şekilde pilot balon şişirildi. Endotrakeal tüp kaf basıncı tüm operasyon süresi boyunca sürekli olarak takip edildi ve her 5 dk’da bir kayıt altına alındı. Hastalar postoperatif 1, 8 ve 24. saatte öksürük, disfoni ve boğaz ağrısı açısından değerlendirildi.
Bulgular: Grupların hemodinamik ve solunumsal parametreleri, sıcaklık değerleri operasyon süresince kaydedildi. Kaf basınçları, postoperatif öksürük, ses kısıklığı ve boğaz ağrısı grup 1 de istatistiksel olarak anlamlı yüksek görüldü (p:0,0001).
Sonuç: Endotrakeal entübasyona bağlı gelişebilecek trakeal morbidite ve buna bağlı komplikasyonları en aza indirebilmek için kaf basınç monitorizasyonun standart haline gelmesi özellikle prone pozisyonundaki operasyonlarda sürekli ölçüm gerektiği sonucuna varıldı.

Keywords

Prone pozisyonu, Endotrakeal entübasyon, Lomber disk hernisi, Boğaz ağrısı, Trakeal hastalıklar

The Effect of Lumbar Disc Hernia Operations in Prone Position on Endotracheal Cuff Pressure and Tracheal Morbidity

Abstract

Background: When the cuffs of endotracheal tubes are inflated with high pressure, serious morbidities are encountered. The aim of our study is to monitor the values of endotracheal tube cuff pressure, which can change in different positions, during the operation and to investigate its effects on tracheal morbidity.
Materials and Methods: Prospective observational study. The age at which general anesthesia with endotracheal intubation was applied to the study; Sixty randomly selected patients in the ASA 1-2 group, 18-80 years old, and Mallampati class 1-2 were included between July 2016 and July 2017. Thirty patients with lumbar disc herniation surgery were divided into 2 groups as group 1 in the prone position, and group 2 in the supine position of 30 patients with lower or upper extremity surgery. After the patients in both groups were intubated in the supine position, the pilot balloon was inflated with an endotracheal cuff manometer between 28-30 cmH2O. Endotracheal tube cuff pressure was continuously monitored throughout the entire operation and recorded every 5 minutes. The patients were evaluated in terms of cough, dysphonia and sore throat at 1, 8 and 24 hours postoperatively.
Results: Hemodynamic and respiratory parameters and temperature values of the groups were recorded during the operation. Cuff pressures, postoperative cough, hoarseness and sore throat were statistically significantly higher in group 1 (p:0.0001).
Conclusion: In order to minimize tracheal morbidity and related complications that may develop due to endotracheal intubation, it was concluded that cuff pressure monitoring should become standard and continuous measurement is required, especially in operations in the prone position.

Keywords

Endotracheal intubation, Lumbar disc herniation, Prone position, Sore throat, Tracheal diseases

References

• 1. Mehta S, Mickiewicz M. Pressure in large volume, low pressure cuffs: its significance, measurement and regulation. IntensiveCareMed 1985; 11(5):267-72.
• 2. Combes X, Schauvliege F, Peyrouset O, Motamed C, Kirov K, Dhonneur G, et al. Intra cuff pressure and tracheal morbidity: influence of filling with saline during nitrous oxide anesthesia. Anesthesiology 2001; 95(5):1120-4.
• 3. Adnet F, Bally B, Pean D. Airway management in adult scheduled anaesthesia (difficult air way excepted)] AnnFrAnesth Reanim 2003;22 Suppl 1:60s-80s.
• 4. Galinski M, Treoux V, Garrigue B, Lapostolle F, Borron SW, Adnet F. Intra cuff pressures of endotracheal tubes in the management of airway emergencies: the need for pressure monitoring. AnnEmergMed 2006; 47(6):545-7.
• 5. Hoffman RJ, Parwani V, Hahn IH. Experienced emergency medicine physicians can not safely inflate or estimate endotracheal tube cuff pressure using Standard techniques.Am J EmergMed 2006; 24(2):139-43.
• 6. Relio J, Sonora R, Jubert P, Artigas A, Rué M, Valles J. Pneumonia in intubated patients: role of respiratory airway care. Am J RespirCritCareMed 1996; 154(1):111-115.
• 7. Braz J R C, Navarro L H C, Takata H I, Junior N P. Endotracheal tube cuff pressure: need for precise measurement. Sao PauloMed J 1999; 117(6):243-7.
• 8. Minonishi T, Kinoshita H, Hirayama M, Kawahito S, Azma T, Hatakeyama N, Fujiwara Y. The supine-to-prone position change induces modification of endotracheal tube cuff pressure accompanied by tube displacement. Journal of ClinicalAnesthesia 2013; 25:28–31.
• 9. Brimacombe J, Keller C, Giampalmo M, Sparr HJ, Berry A (1999) Direct measurement of mucosal pressures exerted by cuff and non-cuff portions of tracheal tubes with different cuff volumes and head and neck positions. Br J Anaesth 82:708–711
• 10. Godoy AC, Vieira RJ, Capitani EM. Endotracheal tube cuff pressure alteration after changes in position in patients under mechanical ventilation. J BrasPneumol 2008; 34(5):294-297.
• 11. Doyle A, Santhirapala R, Crowe M, Blunt M, Young P. The pressure exerted on the tracheal wall by two endotracheal tube cuffs: A prospective observational bench-top, clinical and radiological study. BMC Anesthesiol 2010; 9:10-21.
• 12. CurielGarcía JA, Guerrero-Romero F, Rodríguez-Morán M. Cuffpressure in endotracheal intubation: should it be routinely measured? GacMedMex 2001; 137: 179-182.
• 13. Sengupta P, Sessler DI, Maglinger P, Wells S, Vogt A, Durrani J, Wadhwa A. Endotracheal tube cuff pressure in three hospitals, and the volume required to produce an appropriate cuff pressure. AACN AdvCritCare 2008 Apr-Jun;19(2):235-43.
• 14. Stewart SL, Secrest JA, Norwood BR, Zachary. A comparison of endotracheal tube cuff pressures using estimation techniques and direct intracuff measurement. R.AANA J 2003 Dec;71(6):443-7.
• 15. Baran İ, Altınsoy S, Yamankılıç Mumcu Ö, Dönmez A. Endotrakeal Kaf İnflasyon Yöntemlerine Bağlı Yüksek İntraoperatif Kaf Basıncı İnsidansı ve Klinik Etkileri. JARSS 2019;27(3):217-223. doi: 10.5222/jarss.2019.41636
• 16. Çardaközü T, Çınar Köse EÖ, Yucal NN, Balcı S. Objective and Subjective Evaluation of Endotracheal Tube Cuff Pressure Between Different Levels of Anesthesia Experiences. KOU Sag Bil Derg. 2023;9(1):39-42. doi:10.30934/kusbed.1144138
• 17. Hung KC, Chang YJ, Chang YP, Ho CN, Lan KM, Chen JY, et al. The impact of esophageal device insertion on cuff pressure of endotracheal tube: a literature review and meta-analysis. Sci Rep 2022;12:18192. https://doi.org/10.1038/s41598-022-21980-0
• 18. Park JH, Lee HJ, Lee SH, Kim JS. Changes in tapered endotracheal tube cuff pressure after changing position to hyperextension of neck: a randomized clinical trial. Medicine 2021;100:29(e26633).
• 19. Jain MK, Tripathi CB. Endotracheal tube cuff pressure monitoring during neurosurgery- Manuel vs. automatic method. Journal of AnaesthesiologyClinicalPharmacology 2011/ vol 27/ıssue 3;358-361
• 20. Baysal Yıldırım Z,Uzunköy A, Cigdem A, Ganidagli S, Ozgonul A. Changes in cuff pressure of endotracheal tube during laparoscopic and open abdominal surgery. SurgEndosc 2012; 26:398–401
• 21. Agarwal A, Nath SS, Goswami D, Gupta D, Dhiraaj S, Singh PK. An evaluation of the efficacy of aspirin and benzydamine hydrochloride gargle for attenuating postoperative sore throat: a prospective, randomized, single-blindstudy. AnesthAnalg 2006; 103(4):1001–3.
• 22. Jaensson M, Gupta A, Nilsson UG. Risk factors for development of postoperative sore throat and hoarseness after endotracheal intubation in women: a secondary analysis. AANA J 2012; 80(4 Suppl): S67–73.
• 23. Tabari M, Soltani G, Zirak N, Alipour M, Khazaeni K. Comparison of Effectiveness of Betamethasone gel Applied to the Tracheal Tube and IV Dexamethasone on Postoperative Sore Throat: A RandomizedControlled Trial. Iran J Otorhinolaryngol 2013; 25(73):215–20.
• 24. Hung NK, Wu CT, Chan SM, Lu CH, Huang YS, Yeh CC, et al. Effect on postoperative sore throat of spraying the endotracheal tube cuff with benzydamine hydrochloride, 10% lidocaine, and 2% lidocaine. AnesthAnalg 2010; 111(4):882–6.
• 25. Jaensson M, Olowsson LL, Nilsson U. Endotracheal tube size and sore throat following surgery: a randomized-controlled study. ActaAnaesthesiolScand 2010; 54(2):147–53.
• 26. Rudra A, Ray S, Chatterjee S, Ahmed A, Ghosh S. Gargling with ketamine attenuates the postoperative sore throat. Indian J Anaesth 2009; 53(1):40–3.
• 27. Banihashem N, Alijanpour E, Hasannasab B, Zarei A. Prophylactic Effects of Lidocaine or Beclomethasone Spray on Post-Operative Sore Throat and Cough after Orotracheal Intubation. IranJ Otorhinolaryngology 2015 ;27(80):179-84. PMID: 26082898; PMCID: PMC4461840.
• 28. Mekhemara NA, El-agwanyb AS, Radi WK, El-Hady SM. Comparative study between benzydamine hydrochloride gel, lidocaine 5% gel andlidocaine 10% spray on endotracheal tube cuff as regards postoperative sore throat. RevBrasAnestesiol 2016; 66(3):242 - 48.
• 29. Souissi H, Fre´chette Y, Murza A, Masse MH, Marsault E, Sarret P, D’Aragon, F, Parent AJ, Sansoucy Y. Intracuff 160 mg alkalinized lidocaine reduces cough upon emergence from N2O-free general anesthesia: a randomized controlled trial. Can J Anesth 2016; 63(7):862-70. DOI 10.1007/s12630-016-0652-8.