Assessment of cuff presure during general anesthesia in adult patients

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 H2O). Our group previously described that 43% of intubated patients had excessive cuff pressures (> 30 cm of H2O) 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 H2O; minimum leak, 25.3 SE ± 1.4 cm H2O; P 30 cm H2O). Using minimum leak technique, 42% of patients had insufficient pressures (<20 cm H2O). 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 H2O higher than the minimum leak technique but no replace to aneroid manometer.

Keywords

• Endotracheal intubation
• Intracuff pressure
• General anaesthesia