Endotracheal Cuff Pressure in Different Positions in Patients Posted for Surgery under General Anaesthesia: An Observational Study

Abstract

Background: The ideal endotracheal tube cuff pressure to prevent aspiration is 20-30cmH2O. Lower pressures will result in aspiration and high pressures will lead to tracheal mucosal injuries. Change in patient position may also lead to change in cuff pressures. Our study mainly aims at measuring the cuff pressures in supine, Trendelenberg, reverse Trendelenberg, neck flexion and rotation to one side.

Methods: This prospective observational study was conducted after obtaining ethical clearance and patient consent. 50 patients of ASA Classes I and II were included. All patients were intubated with Romson cuffed endotracheal tubes of size 7.5mm for females and 8.5mm for males. The cuff was inflated and cuff pressure set at 28cm H2O using CuffillsR syringe. With head in neutral position, cuff pressure was measured in 15 degree Trendelenberg and reverse Trendelenberg positions. Using angle meter app, the angles were fixed for flexion, extension, and rotation to one side at 30 degrees. The cuff pressure was recorded after 120 seconds after placing the patient in all these positions.

Results: The cuff pressure increased by 12.48cm H2O flexion and the cuff pressure increased to 33.22cm H2O in extension. The cuff pressure increased to 38.10cmH2O on rotation, increased by 10.58cmH2O from neutral position in Trendelenberg position and increased by 8.74cmH2O in reverse Trendelenberg position.

Conclusion: The cuff pressure changed significantly in all the positions.