Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2018.01.015
Brazilian Journal of Anesthesiology
Scientific Article

Comparison of endotracheal tube cuff pressure changes using air versus nitrous oxide in anesthetic gases during laparoscopic abdominal surgeries

Comparação de alterações na pressão do balonete do tubo endotraqueal usando ar versus óxido nitroso nos gases anestésicos durante cirurgias abdominais laparoscópicas

Shweta Sarjerao Mogal; Lipika Baliarsing; Raylene Dias; Pinakin Gujjar

http://dx.doi.org/10.1016/j.bjane.2018.01.015 Braz J Anesthesiol, vol.68, n4, p.369-374, 2018
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Abstract

Abstract Background and objectives The purpose of this study was to compare the endotracheal tube cuff pressure changes during laparoscopic surgeries using air versus nitrous-oxide in anesthetic gas mixture; and to observe the incidences of postoperative sore throat, hoarseness and dysphagia. Methods Total 100 patients scheduled for elective laparoscopic abdominal surgery were allocated into two groups. Group A (n = 50) received air while Group N (n = 50) received nitrous-oxide in anesthetic gas mixture. After endotracheal intubation, cuff was inflated with air to achieve sealing pressure. Cuff pressure at baseline (sealing pressure), 30 min, 60 min and 90 min was recorded with a manometer. Incidence of sore throat, hoarseness and dysphagia was noted at the time of discharge from post-anesthesia care unit and 24 h after extubation. Results Cuff pressure increased from baseline in both the groups. The increase in cuff pressure in Group N was greater than that in Group A at all time points studied (p < 0.001). Within Group A, cuff pressure increased more at 90 min than at 30 min (p < 0.05). Within Group N, increase in cuff pressure was more at each time point (30, 60 and 90 min) than its previous time point (p < 0.05). The incidence of sore throat in post-anesthesia care unit was higher in Group N than in Group A. Conclusion Use of nitrous-oxide during laparoscopy increases cuff pressure resulting in increased incidence of postoperative sore throat. Cuff pressure should be monitored routinely during laparoscopy with nitrous-oxide anesthesia.

Keywords

Anesthesia, Endotracheal cuff pressure, Laparoscopy, Nitrous oxide

Resumo

Resumo Justificativa e objetivos O objetivo deste estudo foi comparar as alterações na pressão do balonete do tubo endotraqueal durante cirurgias laparoscópicas usando ar versus óxido nitroso na mistura dos gases anestésicos e observar a incidência de dor de garganta, rouquidão e disfagia no pós-operatório. Métodos No total, 100 pacientes agendados para cirurgia abdominal laparoscópica eletiva foram alocados em dois grupos: Grupo A (n = 50) recebeu ar e Grupo N (n = 50) recebeu óxido nitroso na mistura de gases anestésicos. Após a intubação endotraqueal, o balonete foi insuflado com ar para obter a pressão de vedação. As pressões do balonete na fase basal (pressão de vedação), aos 30 min, 60 min e 90 min foram registradas com um manômetro. A incidência de dor de garganta, rouquidão e disfagia foi observada no momento da alta da sala de recuperação pós-anestésica e 24 horas após a extubacão. Resultados A pressão do balonete aumentou em ambos os grupos, comparada à pressão basal. O aumento da pressão do balonete foi maior no Grupo N do que no Grupo A em todos os tempos avaliados (p < 0,001). No Grupo A, o aumento da pressão do balonete foi maior aos 90 min do que aos 30 min (p < 0,05). No Grupo N, o aumento da pressão do balonete foi maior em cada um dos tempos (30, 60 e 90 min) do que no tempo anteriormente mensurado (p < 0,05). A incidência de dor de garganta na sala de recuperação pós-anestésica foi maior no Grupo N do que no Grupo A. Conclusão O uso de óxido nitroso durante a laparoscopia aumenta a pressão do balonete, resulta em aumento na incidência de dor da garganta no pós-operatório. A pressão do balonete deve ser rotineiramente monitorada durante a laparoscopia sob anestesia com óxido nitroso.

Palavras-chave

Anestesia, Pressão do balonete endotraqueal, Laparoscopia, Óxido nitroso

References

Combes X, Schauvliege F, Peyrouset O. Intracuff pressure and tracheal morbidity: influence of filling with saline during nitrous oxide anesthesia. Anesthesiology. 2001;95:1120-4.

Seegobin RD, van Hasselt GL. Endotracheal cuff pressure and tracheal mucosal blood flow: endoscopic study of effects of four large volume cuffs. Br Med J (Clin Res Ed). 1984;288:965-8.

Yildirim ZB, Uzunkoy A, Cigdem A. Changes in cuff pressure of endotracheal tube during laparoscopic and open abdominal surgery. Surg Endosc. 2012;26:398-401.

Stanley TH, Kawamura R, Graves C. Effects of nitrous oxide on volume and pressure of endotracheal tube cuffs. Anesthesiology. 1974;41:256-62.

Tu HN, Saidi N, Leiutaud T. Nitrous oxide increases endotracheal cuff pressure and the incidence of tracheal lesions in anesthetized patients. Anesth Analg. 1999;89:187-90.

Joshi GP. Rapid recovery from ambulatory surgery: the new paradigm in ambulatory anesthesia. IARS Review Course Lectures. 2013.

Peyton PJ, Chao I, Weinberg L. Nitrous oxide diffusion and the second gas effect on emergence from anesthesia. Anesthesiology. 2011;114:596-602.

Hopkins PM. Nitrous oxide: a unique drug of continuing importance for anaesthesia. Best Pract Res Clin Anaesthesiol. 2005;19:381-9.

Braz JR, Navarro LH, Takata IH. Endotracheal tube cuff pressure: need for precise measurement. Sao Paulo Med J. 1999;117:243-7.

Sengupta P, Sessler DI, Maglinger P. Endotracheal tube cuff pressure in three hospitals, and the volume required to produce an appropriate cuff pressure. BMC Anesthesiol. 2004;4:8.

Geng G, Hu J, Huang S. The effect of endotracheal tube cuff pressure change during gynecological laparoscopic surgery on postoperative sore throat: a control study. J Clin Monit Comput. 2015;29:141-4.

Braz JR, Volney A, Navarro LH. Does sealing endotracheal tube cuff pressure diminish the frequency of postoperative laryngotracheal complaints after nitrous oxide anesthesia?. J Clin Anesth. 2004;16:320-5.

Suzuki N, Kooguchi K, Mizobe T. Postoperative hoarseness and sore throat after tracheal intubation: effect of a low intracuff pressure of endotracheal tube and the usefulness of cuff pressure indicator. Masui. 1999;48:1091-5.

Mandoe H, Nikolajsen L, Lintrup U. Sore throat after endotracheal intubation. Anesth Analg. 1992;74:897-900.

Abballe C, Camaioni D, Mascaro A. Anesthesia for laparoscopic cholecystectomy: the use of nitrous oxide in the anesthetic mixture. G Chir. 1993;14:493-5.

Taylor E, Feinstein R, White PF. Anesthesia for laparoscopic cholecystectomy: is nitrous oxide contraindicated?. Anesthesiology. 1992;76:541-3.

Fernández-Guisasola J, Gómez-Arnau JI, Cabrera Y. Association between nitrous oxide and the incidence of postoperative nausea and vomiting in adults: a systematic review and meta-analysis. Anaesthesia. 2010;65:379-87.

Schönherr ME, Hollmann MW, Graf B. Nitrous oxide. Sense or nonsense for today's anaesthesia. Anaesthesist. 2004;53:796-812.

Mencke T, Echternach M, Kleinschmidt S. Laryngeal morbidity and quality of tracheal intubation: a randomized controlled trial. Anesthesiology. 2003;98:1049-56.

Mencke T, Echternach M, Plinkert PK. Does the timing of tracheal intubation based on neuromuscular monitoring decrease laryngeal injury?. A randomized, prospective, controlled trial. Anesth Analg. 2006;102:306-12.

Wu CY, Yeh YC, Wang MC. Changes in endotracheal tube cuff pressure during laparoscopic surgery in head-up or head-down position. BMC Anesthesiol. 2014;14:75.

Lizy C, Swinnen W, Labeau S. Cuff pressure of endotracheal tubes after changes in body position in critically ill patients treated with mechanical ventilation. Am J Crit Care. 2014;23:e1-8.

Rauh R, Hemmerling TM, Rist M. Influence of pneumoperitoneum and patient positioning on respiratory system compliance. J Clin Anesth. 2001;13:361-5.

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