Changes of Endotracheal Tube Cuff Pressures After Ear, Head and Neck Surgery Positions
Condition: Endotracheal Tube Cuff Pressure; Surgery; Ear; Surgery; Head and Neck; Position
Study type: Observational [Patient Registry]

Summary: 
      Increased or decreased intracuff pressures (ICPs) of cuffed endotracheal tubes (cETTs) can
      lead to many morbidities.The ICPs of cETTs can be changed by the the patients' ear and
      head&neck surgery positions. We performed this study to show the effect of the routine
      combination of neck positions on ICP whilst ear and head& neck surgeries.

      A total of 90 patients were enrolled to the study. Groups 1 and 2 included the patients who
      underwent right and left ear surgeries, respectively. Group 3 included all patients
      undergoing head and neck surgery.After the general anesthesia induction, the patients were
      given a neutral position.The first ICP was measured and adjusted to 18,4 mm Hg (25 cmH2O) at
      neutral position. Left or right neck rotation was applied to Group 1 or 2 in conformity with
      the ear operation site and ICP value was documented. Gel pillow with the height of 4,5 cm was
      placed under the shoulders of Group 3 patients to extend the neck and the ICP was noted.
      Then, right or left neck rotation was applied depending on the operation side and ICP was
      documented again. Additionally, ICP values were monitorized continuously in all patients
      during the surgeries, and documented at 15th, 30th, 60th and 90th minutes at related
      positions and just before extubation at neutral position. If the ICP value fell below 14,7
      mmHg (20 cmH2O) or rose above 22 mmHg (30 cmH2O), ICP was adjusted to 18,4 mm Hg (25 cmH2O)
      again.
    

Detailed description: 
      Increased or decreased intracuff pressures (ICPs) of cuffed endotracheal tubes (cETTs) can
      lead to many morbidities. Guidelines recommend that the ICP should be kept between 20 and 30
      cmH2O. Over inflation of the cuff can cause tracheal mucosal injury ,tracheal stenosis,
      tracheoesophageal fistula, postoperative stridor, laryngospasm, laryngeal nerve damage and
      tracheal rupture. However, under inflation can cause air leakage, aspiration and ventilation
      associated pneumonia.The cETT can be displaced by movement of the patients' heads and necks
      while positioning for surgeries of ear, head and neck. These positionings and displacements
      may be the reasons of changes in ICPs. The investigators performed this study to show the
      effect of the routine combination of neck positions on ICP whilst ear, head and neck
      surgeries.

      After obtaining ethics committee approval and written informed consent, 90 patients with
      American Society of Anesthesiologists (ASA) physical status I-III and aged older than 18
      years were enrolled to the study. The patients were allocated to 3 groups according to their
      surgery types. Groups 1 and 2 included the patients who underwent right and left ear
      surgeries, respectively. Group 3 included all patients undergoing head and neck surgery
      without considering the surgical site. After the general anesthesia induction, the patients
      were given a neutral position defined by Komasawa et al. The first ICP was measured and
      adjusted to 18,4 mm Hg (25 cmH2O) at neutral position just after taping the tube and
      monitoring the 3 consecutive respiration cycles. After neutral measurements, left or right
      neck rotation (approximately 60-70 degree to the opposite site) was applied to Group 1 or 2
      in conformity with the ear operation site and ICP value was documented following 3
      respiration cycles. Gel pillow with the height of 4,5 cm was placed under the shoulders of
      Group 3 patients to extend the neck. After waiting for 3 respiration cycles, the ICP was
      noted. Then, right or left neck rotation was applied depending on the operation site
      (approximately 60-70 degree to the opposite site). Following 3 respiration cycles, ICP was
      documented again. Additionally, ICP values were monitorized continuously in all patients
      during the surgeries, and documented at 15th, 30th, 60th and 90th minutes at related
      positions and just before extubation at neutral position. At any time point, if ICP value
      fell below 14,7 mmHg (20 cmH2O) or rose above 22 mmHg (30 cmH2O), ICP was adjusted to 18,4 mm
      Hg (25 cmH2O) again. After all data were collected, statistical analysis were performed by
      using Statistical Package for the Social Sciences (SPSS) version 22.
    

Intervention name(s): Intracuff pressure measurement; Intracuff pressure measurement; Intracuff pressure measurement
Intervention type(s): Other; Other; Other
Intervention description(s): Intracuff pressure values were monitorized and noted before and after head and neck positions and during the surgeries at 15th, 30th, 60th and 90th minutes at related positions and just before extubation at neutral position.; Intracuff pressure values were monitorized and noted before and after head and neck positions and during the surgeries at 15th, 30th, 60th and 90th minutes at related positions and just before extubation at neutral position.; Intracuff pressure values were monitorized and noted before and after head and neck positions and during the surgeries at 15th, 30th, 60th and 90th minutes at related positions and just before extubation at neutral position.
Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Patients scheduled for elective ear or head and neck surgery under general anesthesia.
      
Keywords: Endotracheal tube cuff pressure; Ear Surgery; Head and Neck Surgery; Position