Factors Affecting Endotracheal Cuff Pressure in Gynecological Cases
Condition: Intubation Complication
Study type: Interventional

Summary: 
      Postoperative airway complications associated with endotracheal intubation can be seen.

      While some of these complications are predictable, some may occur urgently. If the
      endotracheal cuff is over-inflated and its pressure is high, mucosal damage resulting from
      mucosal pressure is one of the main factors for tracheal morbidity. Endotracheal tube cuff
      pressure is not routinely measured. It was confirmed that the palpation of the pilot balloon
      was insufficient to detect high cuff pressures. In laparoscopic cases, the investigators
      aimed to investigate whether the increase in intra-abdominal pressure as a result of carbon
      dioxide insufflation, and the change of respiratory functions after trendelenburg position
      are effective on cuff pressure and whether there is a difference compared to laparotomic
      cases.
    

Detailed description: 
      It was planned to include 50 patients in the American Anesthesiologists Association (ASA) 1-3
      risk score group, which will be an elective gynecological operation between the ages of
      18-70. When patients arrive in the operating room, after the ECG, pulse oximeter,
      non-invasive pressure monitoring is provided in the supine position, 18 gauge intravenous(iv)
      vascular access will be opened and balanced fluid 4-6 ml / kg / h will be inserted.
      Anesthesia induction with midazolam 0.05 mg / kg, propofol 2-3 mg / kg, Fentanyl 1-2 µg / kg
      and rocuronium 0.6 mg / kg will be achieved after 3 minutes of preoxygenation. he muscle
      relaxant effect will be monitored by monitoring TOF (train of four), and after sufficient
      relaxation (TOF 95%), the anesthetist will be intubated with the 7-7.5 number endotracheal
      tube suitable for the high-volume low-pressure patient. The cuff of the endotracheal tube
      will be inflated with the help of an injector and the cuff will be attached to the manometer.
      Cuff pressures will be inflated to 25 mmHg. The patients will be given oxygen at 40% and air
      at 3lt / min. The maintenance of anesthesia will be achieved with sevoflurane and 0.05-0.1mcg
      / kg / min remifentanil infusion.

      If the patient feels pain in the perioperative period, 50 mcg fentanyl iv will be used as
      rescue analgesia. During the operation, rokurunium (0.2mg / kg) boluses will be delivered
      according to the patient's clinic and the TOF value between 0-2 (depending on the type of
      surgery). Mechanical ventilation will be started in volume controlled mode with 6-8 ml / kg
      tidal volume, and 12 frequencies. Respiratory frequencies,tidal volume and positive end
      expiratory pressure (PEEP) values of patients will be optimized so that end tidal CO2 is
      35-45 mmHg throughout the case. At the end of surgery, 100 mg tramadol and 1 g paracetamol
      will be administered to patients for the purpose of postoperative analgesia. Patients will be
      extubated after the muscle relaxant is recurrentized with 0.03mg / kg neostigmine and 0.01mg
      / kg atropine.

      If the patient's numeric rating scale (NRS) score is 3 or more during recovery, 0.3 mg / kg
      Petidine hydrochloride will be applied as rescue analgesia. The 'Case Tracking Form' prepared
      for the follow-up of the research will be recorded demographically, age, height, weight and
      BMI information of the patients in the preoperative period.

      In the perioperative period, cuff pressures in the supine position after intubation, at the
      5th, 15th, 30th, 45th minutes and before extubation will be measured and recorded with the
      cuff manometer. In addition to the follow-up form, intra-abdominal pressure, PEEP, P peak and
      P plateau values, anesthesia time, operation time during each measurement will be recorded.
      Patients who were followed-up in the recovery were evaluated by the service nurse who did not
      know how to work in the service at the postoperative 1st, 12th, 24th hours, and the NRS
      (numeric rating scale) (0 is painless, 10 is the most painful and will be asked to describe
      the pain from 1 to 10); It will be evaluated in terms of dysphagia, cough, sore throat,
      hoarseness.
    

Intervention name(s): manometer
Intervention type(s): Device
Intervention description(s): cuff pressure to be measured with manometer
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Endotracheal tube pressure will be measured in the surgical technique using 2 different methods.(laparoscopic and laprotomic)
Masking: Triple (Participant, Investigator, Outcomes Assessor)
Primary purpose: Prevention