Assessment of cuff presure during general anesthesia in adult patients

• Published in: Revista medica del hospital general de mexico s.s.a Vol. 77; no. 4; pp. 167 - 172
• Main Authors: Ramírez, Ylián, Tripp, Francisca L, Sandoval, Lizbeth, Santana, Ángel D, Jiménez, Fiacro
• Format: Journal Article
• Language: English
• Published: Masson Doyma México S.A 01.10.2014; Permanyer
• Subjects: Anestesia general; Endotracheal intubation; General anaesthesia; Intracuff pressure; Intubación endotraqueal; Manguito neumotaponador; Medical/Surgical; Anestesia general; General anaesthesia; Intubación endotraqueal; Intracuff pressure; Manguito neumotaponador; Endotracheal intubation
• ISSN: 0185-1063
• DOI: 10.1016/j.hgmx.2014.10.004

Abstract Background The insufflation pressure of tracheal tubes is usually determined by the finger-pressure technique has low precision. The minimum leak technique is an alternative to determine whether the cuff is occluding the trachea with safe pressures (20-30 cm of H2 O). Our group previously described that 43% of intubated patients had excessive cuff pressures (> 30 cm of H2 O) when the finger-pressure technique was used. Objective To compare the finger-pressure and minimum leak techniques to achieve safe intracuff pressures in patients undergoing endotracheal intubation. Data was analyzed with t -student and lineal regression. Methods Adult surgical patients requiring intubation were randomized in two groups in which cuff insufflation was checked by either the finger-pressure or minimum leak technique. After insufflation, the intracuff pressure was measured using an aneroid manometer. Data analysis was performed to evaluate variables that may affect performance. Result Our study included 286 patients (216 female) with a mean age of 44.6 SE ± 14.9 years. The mean insufflation pressures differed significantly between groups (finger-pressure, 36.9 SE ± 1.9 cm H2 O; minimum leak, 25.3 SE ± 1.4 cm H2 O; P < 0.0001). Each group had 35% of patients with pressures within safe limits. Using finger-pressure, 46% of patient had excessive pressures (>30 cm H2 O). Using minimum leak technique, 42% of patients had insufficient pressures (<20 cm H2 O). We found a consistent association between the intracuff pressure and the body mass index (r2 = 0.223, P < 0.0001). Conclusions Finger-pressure insufflation technique gave mean pressures 11 cm H2 O higher than the minimum leak technique but no replace to aneroid manometer.