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Published in: BMC Anesthesiology 1/2010

Open Access 01-12-2010 | Research article

Tracheal tube and laryngeal mask cuff pressure during anaesthesia - mandatory monitoring is in need

Authors: Kim Z Rokamp, Niels H Secher, Ann M Møller, Henning B Nielsen

Published in: BMC Anesthesiology | Issue 1/2010

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Abstract

Background

To prevent endothelium and nerve lesions, tracheal tube and laryngeal mask cuff pressure is to be maintained at a low level and yet be high enough to secure air sealing.

Method

In a prospective quality-control study, 201 patients undergoing surgery during anaesthesia (without the use of nitrous oxide) were included for determination of the cuff pressure of the tracheal tubes and laryngeal masks.

Results

In the 119 patients provided with a tracheal tube, the median cuff pressure was 30 (range 8 - 100) cm H2O and the pressure exceeded 30 cm H2O (upper recommended level) for 54 patients. In the 82 patients provided with a laryngeal mask, the cuff pressure was 95 (10 - 121) cm H2O and above 60 cm H2O (upper recommended level) for 56 patients and in 34 of these patients, the pressure exceeded the upper cuff gauge limit (120 cm H2O). There was no association between cuff pressure and age, body mass index, type of surgery, or time from induction of anaesthesia to the time the cuff pressure was measured.

Conclusion

For maintenance of epithelia flow and nerve function and at the same time secure air sealing, this evaluation indicates that the cuff pressure needs to be checked as part of the procedures involved in induction of anaesthesia and eventually checked during surgery.
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Literature
1.
go back to reference Nordin U: The trachea and cuff-induced tracheal injury. An experimental study on causative factors and prevention. Acta Otolaryngol Suppl. 1977, 345: 1-71.PubMed Nordin U: The trachea and cuff-induced tracheal injury. An experimental study on causative factors and prevention. Acta Otolaryngol Suppl. 1977, 345: 1-71.PubMed
2.
go back to reference Carrol R, Hedden M, Safar P: Intratracheal cuffs: performance characteristics. Anesthesiology. 1969, 31: 275-81.CrossRef Carrol R, Hedden M, Safar P: Intratracheal cuffs: performance characteristics. Anesthesiology. 1969, 31: 275-81.CrossRef
3.
go back to reference 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. 1984, 288: 965-8.CrossRef 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. 1984, 288: 965-8.CrossRef
4.
go back to reference Friedrich T, Hänsch U, Eichfeld U, Steinert M, Staemmler A, Schönfelder M: Recurrent laryngeal nerve paralysis as intubation injury?. Chirurg. 2000, 71: 539-44.CrossRefPubMed Friedrich T, Hänsch U, Eichfeld U, Steinert M, Staemmler A, Schönfelder M: Recurrent laryngeal nerve paralysis as intubation injury?. Chirurg. 2000, 71: 539-44.CrossRefPubMed
5.
go back to reference Wason R, Gupta P, Gogia AR: Bilateral adductor vocal cord paresis following endotracheal intubation for general anaesthesia. Anaesth Intensive Care. 2004, 32: 417-8.PubMed Wason R, Gupta P, Gogia AR: Bilateral adductor vocal cord paresis following endotracheal intubation for general anaesthesia. Anaesth Intensive Care. 2004, 32: 417-8.PubMed
6.
go back to reference Endo K, Okabe Y, Maruyama Y, Tsukatani T, Furukawa M: Bilateral vocal cord paralysis caused by laryngeal mask airway. Am J Otolaryngol. 2007, 28: 126-9.CrossRefPubMed Endo K, Okabe Y, Maruyama Y, Tsukatani T, Furukawa M: Bilateral vocal cord paralysis caused by laryngeal mask airway. Am J Otolaryngol. 2007, 28: 126-9.CrossRefPubMed
7.
go back to reference Stewart A, Lindsay WA: Bilateral hypoglossal nerve injury following the use of the laryngeal mask airway. Anaesthesia. 2002, 57: 264-5.CrossRefPubMed Stewart A, Lindsay WA: Bilateral hypoglossal nerve injury following the use of the laryngeal mask airway. Anaesthesia. 2002, 57: 264-5.CrossRefPubMed
8.
go back to reference Brimacombe J, Clarke G, Keller C: Lingual nerve injury associated with the ProSeal laryngeal mask airway: a case report and review of the literature. Br J Anaesth. 2005, 95: 420-3.CrossRefPubMed Brimacombe J, Clarke G, Keller C: Lingual nerve injury associated with the ProSeal laryngeal mask airway: a case report and review of the literature. Br J Anaesth. 2005, 95: 420-3.CrossRefPubMed
9.
go back to reference Keller C, Puehringer F, Brimacombe J: The influence of cuff volume on oropharyngeal leak pressure and fibreoptic position with the laryngeal mask airway. Br J Anaesth. 1998, 81: 186-7.CrossRefPubMed Keller C, Puehringer F, Brimacombe J: The influence of cuff volume on oropharyngeal leak pressure and fibreoptic position with the laryngeal mask airway. Br J Anaesth. 1998, 81: 186-7.CrossRefPubMed
10.
go back to reference Brimacombe J, Keller C, Morris R, Mecklem D: A comparison of the disposable versus the reusable laryngeal mask airway in paralyzed adult patients. Anesth Analg. 1998, 87: 921-4.PubMed Brimacombe J, Keller C, Morris R, Mecklem D: A comparison of the disposable versus the reusable laryngeal mask airway in paralyzed adult patients. Anesth Analg. 1998, 87: 921-4.PubMed
11.
go back to reference Burgard G, Mollhoff T, Prien T: The effect of laryngeal mask cuff pressure on postoperative sore throat incidence. J Clin Anesth. 1996, 8: 198-201.CrossRefPubMed Burgard G, Mollhoff T, Prien T: The effect of laryngeal mask cuff pressure on postoperative sore throat incidence. J Clin Anesth. 1996, 8: 198-201.CrossRefPubMed
12.
go back to reference Brimacombe J, Holyoake L, Keller C, Brimacombe N, Scully M, Barry J, Talbutt P, Sartain J, McMahon P: Pharyngolaryngeal neck and jaw discomfort after anaesthesia with the face mask and laryngeal mask airway at high and low cuff volumes in males and females. Anesthesiology. 2000, 93: 26-31.CrossRefPubMed Brimacombe J, Holyoake L, Keller C, Brimacombe N, Scully M, Barry J, Talbutt P, Sartain J, McMahon P: Pharyngolaryngeal neck and jaw discomfort after anaesthesia with the face mask and laryngeal mask airway at high and low cuff volumes in males and females. Anesthesiology. 2000, 93: 26-31.CrossRefPubMed
13.
go back to reference Wong JG, Heaney M, Chambers NA, Erb TO, von Ungern-Sternberg BS: Impact of laryngeal mask airway cuff pressures on the incidence of sore throat in children. Paediatr Anaesth. 2009, 19: 464-9.CrossRefPubMed Wong JG, Heaney M, Chambers NA, Erb TO, von Ungern-Sternberg BS: Impact of laryngeal mask airway cuff pressures on the incidence of sore throat in children. Paediatr Anaesth. 2009, 19: 464-9.CrossRefPubMed
14.
go back to reference Wajed SA, Streets CG, Bremner CG, DeMeester TR: Elevated body mass disrupts the barrier to gastroesophageal reflux. Arch Surg. 2001, 136: 1014-8.CrossRefPubMed Wajed SA, Streets CG, Bremner CG, DeMeester TR: Elevated body mass disrupts the barrier to gastroesophageal reflux. Arch Surg. 2001, 136: 1014-8.CrossRefPubMed
15.
go back to reference Pelosi P, Croci M, Ravagnan I, Tredici S, Pedoto A, Lissoni A, Gattinoni L: The effects of body mass on lung volumes, respiratory mechanics, and gas exchange during general anaesthesia. Anesth Analg. 1998, 87: 654-60.PubMed Pelosi P, Croci M, Ravagnan I, Tredici S, Pedoto A, Lissoni A, Gattinoni L: The effects of body mass on lung volumes, respiratory mechanics, and gas exchange during general anaesthesia. Anesth Analg. 1998, 87: 654-60.PubMed
16.
go back to reference 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. BMC Anesthesiol. 2004, 4: 8-CrossRefPubMedPubMedCentral 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. BMC Anesthesiol. 2004, 4: 8-CrossRefPubMedPubMedCentral
17.
go back to reference Galinski M, Tréoux V, Garrigue B, Lapostolle F, Borron SW, Adnet F: Intracuff pressures of endotracheal tubes in the management of airway emergencies: the need for pressure monitoring. Ann Emerg Med. 2006, 47: 545-7.CrossRefPubMed Galinski M, Tréoux V, Garrigue B, Lapostolle F, Borron SW, Adnet F: Intracuff pressures of endotracheal tubes in the management of airway emergencies: the need for pressure monitoring. Ann Emerg Med. 2006, 47: 545-7.CrossRefPubMed
18.
go back to reference Hoffman RJ, Parwani V, Hahn IH: Experienced emergency medicine physicians cannot safely inflate or estimate endotracheal tube cuff pressure using standard techniques. Am J Emerg Med. 2006, 24: 139-43.CrossRefPubMed Hoffman RJ, Parwani V, Hahn IH: Experienced emergency medicine physicians cannot safely inflate or estimate endotracheal tube cuff pressure using standard techniques. Am J Emerg Med. 2006, 24: 139-43.CrossRefPubMed
19.
go back to reference Stewart SL, Secrest JA, Norwood BR, Zachary R: A comparison of endotracheal tube cuff pressures using estimation techniques and direct intracuff measurement. AANA J. 2003, 71: 443-7.PubMed Stewart SL, Secrest JA, Norwood BR, Zachary R: A comparison of endotracheal tube cuff pressures using estimation techniques and direct intracuff measurement. AANA J. 2003, 71: 443-7.PubMed
20.
go back to reference Hoffman RJ, Dahlen JR, Lipovic D, Stürmann KM: Linear Correlation of Endotracheal Tube Cuff Pressure and Volume. West J Emerg Med. 2009, 10: 137-9.PubMedPubMedCentral Hoffman RJ, Dahlen JR, Lipovic D, Stürmann KM: Linear Correlation of Endotracheal Tube Cuff Pressure and Volume. West J Emerg Med. 2009, 10: 137-9.PubMedPubMedCentral
21.
go back to reference Kunitz O, Jansen R, Ohnsorge E, Haaf-vonBelow S, Schulz-Stübner S, Rossaint R: Cuff pressure monitoring and regulation in adults. Anaesthesist. 2004, 53: 334-40.CrossRefPubMed Kunitz O, Jansen R, Ohnsorge E, Haaf-vonBelow S, Schulz-Stübner S, Rossaint R: Cuff pressure monitoring and regulation in adults. Anaesthesist. 2004, 53: 334-40.CrossRefPubMed
22.
go back to reference Dullenkopf A, Bernet-Buettiker V, Maino P, Weiss M: Performance of a novel pressure release valve for cuff pressure control in pediatric tracheal tubes. Paediatr Anaesth. 2006, 16: 19-24.CrossRefPubMed Dullenkopf A, Bernet-Buettiker V, Maino P, Weiss M: Performance of a novel pressure release valve for cuff pressure control in pediatric tracheal tubes. Paediatr Anaesth. 2006, 16: 19-24.CrossRefPubMed
23.
go back to reference Weiss M, Dullenkopf A, Fischer JE, Keller C, Gerber AC: Prospective randomized controlled multi-centre trial of cuffed or uncuffed endotracheal tubes in small children. Br J Anaesth. 2009, 103: 867-73.CrossRefPubMed Weiss M, Dullenkopf A, Fischer JE, Keller C, Gerber AC: Prospective randomized controlled multi-centre trial of cuffed or uncuffed endotracheal tubes in small children. Br J Anaesth. 2009, 103: 867-73.CrossRefPubMed
24.
go back to reference Dullenkopf A, Gerber AC, Weiss M: Nitrous oxide diffusion into tracheal tube cuffs: comparison of five different tracheal tube cuffs. Acta Anaesthesiol Scand. 2004, 48: 1180-4.CrossRefPubMed Dullenkopf A, Gerber AC, Weiss M: Nitrous oxide diffusion into tracheal tube cuffs: comparison of five different tracheal tube cuffs. Acta Anaesthesiol Scand. 2004, 48: 1180-4.CrossRefPubMed
25.
go back to reference Keller C, Brimacombe JR: Laryngeal mask airway intracuff pressure estimation by digital palpation of the pilot balloon: a comparison of reusable and disposable masks. Anaesthesia. 1999, 54: 183-186.CrossRefPubMed Keller C, Brimacombe JR: Laryngeal mask airway intracuff pressure estimation by digital palpation of the pilot balloon: a comparison of reusable and disposable masks. Anaesthesia. 1999, 54: 183-186.CrossRefPubMed
26.
go back to reference Braz JR, Navarro LH, Takata IH, Nascimento Júnior P: Endotracheal tube cuff pressure: need for precise measurement. Sao Paulo Med J. 1999, 117: 243-7.CrossRefPubMed Braz JR, Navarro LH, Takata IH, Nascimento Júnior P: Endotracheal tube cuff pressure: need for precise measurement. Sao Paulo Med J. 1999, 117: 243-7.CrossRefPubMed
Metadata
Title
Tracheal tube and laryngeal mask cuff pressure during anaesthesia - mandatory monitoring is in need
Authors
Kim Z Rokamp
Niels H Secher
Ann M Møller
Henning B Nielsen
Publication date
01-12-2010
Publisher
BioMed Central
Published in
BMC Anesthesiology / Issue 1/2010
Electronic ISSN: 1471-2253
DOI
https://doi.org/10.1186/1471-2253-10-20

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