Evaluation of the role of continuous endotracheal tube cuff pressure monitoring in the incidence of endotracheal tube-associated complications in elective laparoscopic abdominal surgeries

Objective: This study aimed to evaluate the effectiveness of continuously monitoring and maintaining endotracheal tube (ETT) cuff pressure within optimal levels in reducing postoperative cuff-related complications in patients undergoing elective laparoscopic abdominal surgery under balanced general anesthesia. Materials and Methods: This prospective, randomized controlled study was conducted on 95 patients aged 18–65 years with ASA class I–II, scheduled for elective laparoscopic surgery under general anesthesia. Patients were randomly assigned into three groups using sealed envelopes. In the first group, cuff inflation was performed using the cuff-leak test (Group K, n=34, control group). In the second group, cuff pressure was adjusted to 25 cmH₂O using a manual manometer and was rechecked every 30 minutes (Group A, n=30). In the third group, cuff pressure was set at 25 cmH₂O and continuously monitored using a pressure transducer connected to the cuff balloon via a three-way stopcock (Group S, n=31). Anesthesia maintenance was achieved using sevoflurane and oxygen/N₂O (40%/60%) in all groups. The tracheal mucosa at the cuff contact area was evaluated using a fiberoptic bronchoscope following intubation and extubation. The primary outcome of the study was the incidence of cuff-related complications at the 2nd and 24th postoperative hours, and differences between the groups were analyzed. Results: At the postoperative 2nd hour, the incidence of cough and sore throat was found to be significantly lower in the continuously monitored group. No significant difference was observed in the incidence of dysphagia, blood-tinged sputum, and hoarseness at the postoperative 2nd and 24th hours. In fiberoptic imaging, the incidence of pinpoint hyperemia was the lowest in the continuously monitored group, with a statistically significant difference. The presence of hyperemia on fiberoptic imaging was found to be associated with sore throat at the postoperative 2nd hour. Conclusion: Maintaining ETT cuff pressure at 25 cmH₂O in laparoscopic surgeries, particularly those utilizing nitrous oxide, reduces tracheal mucosal injury and decreases the incidence of ETT cuff pressure-related complications. Therefore, continuous cuff pressure monitoring and regulation may be a safer approach in laparoscopic surgeries where nitrous oxide is used. Keywords: Laparoscopic surgery, continuous cuff pressure monitoring, cuff-related complications, nitrous oxide, sore throat