Endotracheal tube cuff pressure increases in patients undergoing shoulder arthroscopy: a single cohort study [Aumento da pressão do balonete do tubo endotraqueal em pacientes submetidos a artroscopia do ombro: estudo de coorte]

Abstract

Background and objectives: Several airway complications can occur during shoulder arthroscopy including airway obstruction, pleural puncture, and subcutaneous emphysema. It was hypothesized that the irrigation fluid used during a shoulder arthroscopic procedure might increase the cuff pressure of the endotracheal tube, which can cause edema and ischemic damage to the endotracheal mucosa. Therefore, this study aimed to evaluate the relationship between irrigation fluid and endotracheal tube cuff pressures. Methods: Forty patients aged 20 to 70 years with an American Society of Anesthesiologists (ASA) score I or II, scheduled for elective arthroscopic shoulder surgery under general anesthesia, participated in our study. We recorded endotracheal tube cuff pressures and neck circumferences every hour from the start of the operation. We also recorded the total duration of the anesthesia, operation, and the total volume of fluid used for irrigation. Results: A positive correlation was shown between endotracheal tube cuff pressures and the amount of irrigation fluid (r = 0.385, 95% CI 0.084 to 0.62, p = 0.0141). The endotracheal tube cuff pressure significantly increased at 2 and 3 hours after starting the operation (p = 0.0368 and p = 0.0245, respectively). However, neck circumference showed no significant difference. Conclusions: Endotracheal tube cuff pressures increased with operation time and with increased volumes of irrigation fluid used in patients who underwent shoulder arthroscopy. We recommend close monitoring of endotracheal tube cuff pressures during shoulder arthroscopy, especially during long operations using a large amount of irrigation fluid, to prevent complications caused by raised cuff pressures. © 2020 Sociedade Brasileira de Anestesiologia