Anesthetic Gas Leakage in Children During Tonsillectomy: a Comparison of Cuffed and Uncuffed Tracheal Tubes
Condition: Exposure to Environmental Pollution; Adverse Effect of Unspecified General Anesthetic
Study type: Interventional

Summary: 
      Fires and operating room pollution may occur when anesthesia gases leak into the oropharynx
      during airway surgery. Investigators sought to measure the concentrations of anesthetic gases
      that leak into the mouth of children undergoing adenotonsillectomy using cuffed and uncuffed
      tracheal tubes during spontaneous and controlled ventilation.
    

Detailed description: 
      For the past 6 decades, uncuffed tubes have been used for the children less than 8 years of
      age out of a fear that cuffed tubes would cause damage to the subglottic region. The correct
      size uncuffed tube creates a seal in the subglottis that has minimal pressure on the mucosa.
      However, cuffed tubes have become more widely used in children recently without causing
      damage to the mucosa. There is very little literature comparing the magnitude of the gas
      leaks with cuffed and uncuffed tracheal tubes particularly in children. Several authors
      suggest that the leak of nitrous oxide and sevoflurane with uncuffed tubes was much greater
      than with cuffed tubes. One important but poorly studied issue is the risk of an airway fire
      when cautery is used for tonsillectomy because a large leak of oxygen in the mouth could
      ignite a fire. It also remains unclear whether the mode of ventilation, spontaneous or
      controlled, affects the leak of gases into the mouth. One might expect that the gas leak with
      spontaneous ventilation is less than with controlled ventilation, but it may not matter in
      the context of the small concentrations of oxygen and sevoflurane that investigators use. To
      address all of these concerns, investigators designed this study to compare the
      concentrations of gases (oxygen, carbon dioxide, nitrous oxide and sevoflurane) in the oral
      cavity of children undergoing T&A with either cuffed or uncuffed tubes, during spontaneous
      and controlled ventilation.
    

Intervention name(s): oxygen concentration; nitrous oxide concentration; carbon dioxide concentration; sevoflurane concentration
Intervention type(s): Drug; Drug; Drug; Drug
Intervention description(s): oxygen concentration will be measured in the tracheal tube and oropharynx during spontaneous or controlled ventilation; nitrous oxide concentration will be measured in the tracheal tube and oropharynx during spontaneous or controlled ventilation; carbon dioxide concentration will be measured from the tracheal tube and in the oropharynx during spontaneous or controlled ventilation; sevoflurane concentration will be measured in the tracheal tube and oropharynx during spontaneous or controlled ventilation
Other intervention name(s): difference in the oxygen concentration; difference in the nitrous oxide concentration; difference in the carbon dioxide concentration; difference in the sevoflurane concentration
Intervention MeSH terms: Nitrous Oxide; Sevoflurane
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Other
Keywords: oxygen; nitrous oxide; sevoflurane; carbon dioxide; endotracheal tube; respiration