Effects Of Different Endotracheal Tube Cuff Management On Airway Complications After Laparoscopic Gynaecological Surgery

Objective:Three different methods were used to manage the endotracheal tube cuff in patients undergoing laparoscopic gynecological surgery with general anesthesia.The cuff pressure and airway pressure were measured and compared,and the tracheal mucosa of the patients was also observed.The incidence and severity of sore throat,hoarseness,and cough at different time points after extubation were compared and analyzed,in order to explore the appropriate cuff management for these patients.Methods:180 patients undergoing laparoscopic gynecological surgery with general anesthesia were randomly divided into three groups:finger kneading method group?group A,n=60?,minimal occlusive volume method group?group B,n=60?and pressure control method group?group C,n=60?.After tracheal intubation,the cuff of endotracheal tube in group A was inflated with air by manual palpation.In group B,the anesthesiologist put the membrane piece of stethoscope on the suprasternal fossa,and the cuff was inflated with air until without leakage by stethoscopic auscultation at the end of inspiratory.In group C,the cuff pressure was continuously measured with specialized cuff pressure gauge and controlled at 30 cmH₂O.The cuff pressure and airway pressure after intubation and mechanical ventilation?T₀?were measured in three groups.and the cuff pressure,airway pressure and pneumoperitoneum pressure were measured at 5 min?T₁?,20 min?T₂?,40min?T₃?,60 min?T₄?after insufflation.The duration of endotracheal tube,operation time and pneumoperitoneum time were also recorded.The tracheal mucosa of twenty patients in each group was observed by fiberoptic bronchoscopy when the endotracheal tube was removed.The occurrence and severity of sore throat,hoarseness and cough in three groups were observed and recorded at 1,6 and 24 hours after extubation.Results:The cuff pressure was significantly lower in group B and C compared with group A at five time points?P<0.05?,no significant difference was found in cuff pressure between group B and C?P>0.05?.The cuff pressure in group A and B was significantly higher at T₁,T₂,T₃,T₄ compared with T₀?P<0.05?,however,no significant difference was found in cuff pressure among T₁,T₂,T₃,T₄ in group A and B?P>0.05?.There was no significant cuff pressure change at five time points in group C?P>0.05?.The airway pressure in three groups was significantly higher at T₁,T₂,T₃,T₄ compared with T₀?P<0.05?,but no significant difference was found in the airway pressure among T₁,T₂,T₃,T₄?P>0.05?,and there was no significant difference in the airway pressure at five time points among the three groups?P>0.05?.The degrees of tracheal mucosal injury in group B and C were less severe than those in group A?P<0.05?,there was no significant difference in the degree of tracheal mucosal injury between group B and C?P>0.05?,no severe tracheal mucosal injury was found in three groups.The incidence and severity of sore throat in group B and C were significantly lower than those in group A at 1h and 6 h after extubation?P<0.05?,there were no significant differences between group B and C?P>0.05?,no significant differences were found in the incidence and severity of sore throat at 24 h after extubation among the three groups?P>0.05?.There were no significant differences in the incidence and severity of sore throat,hoarseness and cough at 1,6 and 24hours after extubation among the three groups?P>0.05?.Conclusion:Both the manometry method and the minimal occlusive volume method could decrease the incidence and severity of sore throat in the short term after extubation in laparoscopic gynecologic surgery.