Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2020.11.002
Brazilian Journal of Anesthesiology
Clinical Research

Endotracheal tube cuff pressure increases in patients undergoing shoulder arthroscopy

Aumento da pressão do balonete do tubo endotraqueal em pacientes submetidos à artroscopia do ombro: estudo de coorte

Hey Ran Choi, Seunghwan Kim, Hyo-Jin Kim, Eun-Jin Ahn, Kyung Woo Kim, Si Ra Bang

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Abstract

Background and objectives
Several airway complications can occur during shoulder arthroscopy including airway obstruction, pleural puncture, and subcutaneous emphysema. It was hypothesized that the irrigation fluid used during a shoulder arthroscopic procedure might increase the cuff pressure of the endotracheal tube, which can cause edema and ischemic damage to the endotracheal mucosa. Therefore, this study aimed to evaluate the relationship between irrigation fluid and endotracheal tube cuff pressures.

Methods
Forty patients aged 20 to 70 years with an American Society of Anesthesiologists (ASA) score I or II, scheduled for elective arthroscopic shoulder surgery under general anesthesia, participated in our study. We recorded endotracheal tube cuff pressures and neck circumferences every hour from the start of the operation. We also recorded the total duration of the anesthesia, operation, and the total volume of fluid used for irrigation.

Results
A positive correlation was shown between endotracheal tube cuff pressures and the amount of irrigation fluid (r = 0.385, 95% CI 0.084 to 0.62, p = 0.0141). The endotracheal tube cuff pressure significantly increased at 2 and 3 hours after starting the operation (p = 0.0368 and p = 0.0245, respectively). However, neck circumference showed no significant difference.

Conclusions
Endotracheal tube cuff pressures increased with operation time and with increased volumes of irrigation fluid used in patients who underwent shoulder arthroscopy. We recommend close monitoring of endotracheal tube cuff pressures during shoulder arthroscopy, especially during long operations using a large amount of irrigation fluid, to prevent complications caused by raised cuff pressures.

Keywords

Manejo das vias aéreas;  Anestesia;  Endotraqueal;  Artroscopia

Resumo

Justificativa e objetivos
Diversas complicações das vias aéreas podem ocorrer durante a artroscopia do ombro, incluindo obstrução das vias aéreas, punção pleural e enfisema subcutâneo. Levantou-se a hipótese de que o fluido de irrigação utilizado durante artroscopia do ombro possa aumentar a pressão do balonete do tubo endotraqueal, podendo causar edema e lesão isquêmica na mucosa traqueal. Portanto, este estudo teve como objetivo avaliar a relação entre o fluido de irrigação e a pressão do balonete do tubo endotraqueal.

Métodos
Participaram do estudo 40 pacientes com idades entre 20 e 70 anos com classificação do estado físico I ou II da Sociedade Americana de Anestesiologistas (ASA), programados para cirurgia artroscópica do ombro, eletiva e sob anestesia geral. Registramos as pressões do balonete do tubo endotraqueal e as circunferências do pescoço a cada hora, a partir do início da cirurgia. Também registramos a duração anestésica e cirúrgica, assim como o volume total de líquido de irrigação empregado.

Resultados
Foi encontrada correlação positiva entre a pressão do balonete do tubo endotraqueal e a quantidade de líquido de irrigação (r = 0,385; 95% IC 0,084 a 0,62; p = 0,0141). A pressão do balonete do tubo endotraqueal registrou aumento significante 2 e 3 horas após o início da cirurgia (p = 0,0368 e p = 0,0245; respectivamente). No entanto, a circunferência do pescoço não mostrou diferença significante.

Conclusões
As pressões do balonete do tubo endotraqueal aumentaram com o tempo de cirurgia e com o aumento do volume de líquido de irrigação utilizado em pacientes submetidos à artroscopia do ombro. Recomendamos a monitorização rigorosa da pressão do balonete do tubo endotraqueal durante artroscopia do ombro, especialmente nos procedimentos longos em que grandes volumes de fluido de irrigação são empregados, para evitar complicações causadas por pressões elevadas do balonete.

Palavras-chave

Airway management;  Anesthesia;  Endotracheal;  Arthroscopy

References

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