The effect of different surgery positions on endotracheal tube cuff pressure: Prospective study

The placement of a cuffed endotracheal tube for the administration of general anesthesia is a routine procedure. In the part of the intubation tube located in the trachea, there is a balloon (cuff) to prevent gase leakage, aspiration of secretions and gastric contents into the lungs. Inadequate inflation of cuff may lead to inadequate ventilation, aspiration and associated complications, while excessive inflation may cause complications in ranging from postoperative pharyngeal complaints to tracheal rupture due to increased cuff pressure. In our study we aimed to observe the effect of different positions on the endotracheal cuff pressure in patients undergoing urological procedures. This is a prospective study conducted on 200 patients undergoing urological procedures in supine, prone, lateral flank and litotomy positions. After intubation (T0), the cuff pressure was checked with a cuff manometer and adjusted to 25 cmH2O and continuously monitored. The cuff pressure was checked again before (T1) and after achieving the final position (T2) and then at 5. (T3), 10. (T4), 15. (T5), 30., 45., 60., 90., 120., 150., 180. minutes of the position, at the end of the procedure (T6) and before extubation (T7). At postoperative 2nd and 12th hours, the patients were interviewed for sore throat, hoarseness and cough. We found a statistically significant increase in the cuff pressure after positioning the patients in litotomy, lateral flank and prone groups (In all 3 groups p<0,001). The highest increase of cuff pressure occurred in patients in the prone group (34,3±7,5 cmH2O). It was observed that cuff pressure was decreased over time in all groups during surgery. There was no significant difference between the groups for postoperative sore throat, cough and hoarseness (p>0,100). However, mean cuff pressure was significantly higher in the patients with postoperative sore throat or cough than the patients without them, at postoperative 2nd hour (p=0,003 for sore throat, p=0,047 for cough). In conclusion, we believe that cuff pressure monitoring is necessary for patient safety and should be included in routine monitoring because of the dynamic course of cuff pressure due to changing patient positions.