A Tapered Cuff Tracheal Tube Decreases the Need for Cuff Pressure Adjustment After Surgical Retraction During Anterior Cervical Spine Surgery: A Randomized Controlled, Double-Blind Trial

Frontiers in Medicine

卷:9

Wen-Cheng Huang¹  Mercedes Susan Mandell²  Ting-Yun Chiang³  Yueh-Ju Tsai⁵  Shiang-Suo Huang⁷  Elise Chia-Hui Tan⁸  Yi-Shiuan Li¹⁰  Wen-Kuei Chang¹⁰  Ya-Chun Chu¹⁰ 

[1] 0Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei City, Taiwan;

[2] Department of Anesthesiology, McGovern Medical School, Memorial Hermann-Texas Medical Center, University of Texas Health, Houston, TX, United States;

[3] Department of Anesthesiology, Taipei Veterans General Hospital, Taipei City, Taiwan;

[4] Department of Anesthesiology, University of Colorado, Aurora, CO, United States;

[5] Department of Otorhinolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei City, Taiwan;

[6] Department of Pharmacology, Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan;

[7] Department of Pharmacy, Chung Shan Medical University Hospital, Taichung, Taiwan;

[8] Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, Hsinchu, Taiwan;

[9] National Research Institute of Chinese Medicine, Ministry of Health and Welfare, Taipei City, Taiwan;

[10] School of Medicine, National Yang Ming Chiao Tung University, Hsinchu, Taiwan;

关键词: anterior cervical spine surgery;    dysphonia;    GRBAS;    tapered cuff;    tracheal tube cuff pressure;   

DOI  :  10.3389/fmed.2022.920726

来源: DOAJ

【 摘 要 】

BackgroundSurgical retraction to expose the vertebrae during anterior cervical spine surgery increases tracheal tube cuff pressure and may worsen postoperative sore throat and dysphonia. This randomized double-blind study investigated the effect of cuff shape on intraoperative cuff pressure and postoperative sore throat and dysphonia.MethodsEighty patients were randomized to tracheal intubation with a tapered cuff or a conventional cylindrical high-volume low-pressure cuff (control) during anesthesia. Intraoperative cuff pressures were compared. The primary outcome was the incidence of pressure adjustment needed when the cuff pressure increased to > 25 mm Hg after surgical retraction. The secondary outcome was the incidence of postoperative sore throat and dysphonia.ResultsThe incidence of pressure adjustment after surgical retraction was significantly lower in the tapered group than in the control group (13% vs. 48%; P = 0.001; relative risk reduction, 74%). The median [interquartile range (IQR)] cuff pressure (mm Hg) was significantly lower for the tapered cuff than for the control cuff before surgical retraction [9 (7–12) vs. 12 (10–15); P < 0.001] and after retraction [18 (15–23) vs. 25 (18–31); P = 0.007]. The median (IQR) postoperative dysphonia score assessed by a single speech-language pathologist was lower in the tapered group than in the control group [4 (3–6) vs. 5.5 (5–7); P = 0.008].ConclusionA tapered cuff tracheal tube decreased the need for the adjustment of cuff pressure after surgical retraction during anterior cervical spine surgery, thereby avoiding intraoperative pressure increase. It also has a better outcome in terms of dysphonia.Clinical Trial Registration[www.clinicaltrials.gov], identifier [NCT04591769].

【 授权许可】

Unknown