A prospective, observational study of changes in endotracheal tube cuff pressure according to different patient positions in neurosurgery

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Saricaoglu Oktem S., ŞAHAP M., BUT A.

ANAESTHESIA, PAIN AND INTENSIVE CARE, vol.29, 2025 (ESCI, Scopus)

Abstract

ABSTRACT
Objective:
Underinflation of the cuff of endotracheal tube (ETT) used during general anesthesia can cause
complications such as air leakage and aspiration during ventilation. At the same time, overinflation can lead to
serious complications such as postoperative sor
e throat, tracheomalacia, and tracheal rupture.
I
n this study, we
aimed to evaluate the effect of different surgical positions
, e.g.,
pron
e
, supine,
and
semi
-
fowler
positions,
on ETT
cuff pressure and the effect of cuff pressure changes on
postoperative sore throat in neurosurgical operations.
Method
ology
:
We included a total of 150 patients (50 patients
each
in
two
group
s
) undergoing neurosurgery in
prone, supine, and semi
-
fowler positions in this prospective and observational study
.
After intubation, ETT cuff
pressure was adjusted to 25 cmH₂O with a manometer (T0), and continuous monitoring was provided by
connecting to the transducer via a three
-
way tap. We recorded the cuff pressure immediately after positioning
the patient (T1), be
fore correcting the position (T18), and after correcting the position (T19). We evaluated
patients for sore throat using the Visual Analog Scale (VAS) after extubation and at the 1st, 12th, and 24th
postoperative hours.
Results:
After positioning, cuff pre
ssure increased only in the pronated group, whereas it decreased in the other
groups. The difABSTRACT
Objective:
Underinflation of the cuff of endotracheal tube (ETT) used during general anesthesia can cause
complications such as air leakage and aspiration during ventilation. At the same time, overinflation can lead to
serious complications such as postoperative sor
e throat, tracheomalacia, and tracheal rupture.
I
n this study, we
aimed to evaluate the effect of different surgical positions
, e.g.,
pron
e
, supine,
and
semi
-
fowler
positions,
on ETT
cuff pressure and the effect of cuff pressure changes on
postoperative sore throat in neurosurgical operations.
Method
ology
:
We included a total of 150 patients (50 patients
each
in
two
group
s
) undergoing neurosurgery in
prone, supine, and semi
-
fowler positions in this prospective and observational study
.
After intubation, ETT cuff
pressure was adjusted to 25 cmH₂O with a manometer (T0), and continuous monitoring was provided by
connecting to the transducer via a three
-
way tap. We recorded the cuff pressure immediately after positioning
the patient (T1), be
fore correcting the position (T18), and after correcting the position (T19). We evaluated
patients for sore throat using the Visual Analog Scale (VAS) after extubation and at the 1st, 12th, and 24th
postoperative hours.
Results:
After positioning, cuff pre
ssure increased only in the pronated group, whereas it decreased in the other
groups. The difference between the prone and semi
-
fowler groups was statistically significant (
P
= 0.042). During
the follow
-
up period, it was determined that the cuff pressure d
ecreased over time in the pron
e
and semi
-
fowler
groups and increased from time to time in the supine group, but the cuff pressures before extubation in all three
groups were significantly lower than the initial values (
P
<
0.001). The supine group had the
highest sore throat
VAS score at the 24th postoperative hour, and this difference was statistically significant (
P
= 0.017).
Conclusion:
To ensure patient safety, we recommend making continuous cuff pressure monitoring a routine
practice, given that ETT
cuff pressure may vary depending on the
patient position.
Keywords:
Position, Prone, Supine, Semi
-
Fowler, Endotracheal Cuff Pressure, Sore Throatference between the prone and semi
-
fowler groups was statistically significant (
P
= 0.042). During
the follow
-
up period, it was determined that the cuff pressure d
ecreased over time in the pron
e
and semi
-
fowler
groups and increased from time to time in the supine group, but the cuff pressures before extubation in all three
groups were significantly lower than the initial values (
P
<
0.001). The supine group had the
highest sore throat
VAS score at the 24th postoperative hour, and this difference was statistically significant (
P
= 0.017).
Conclusion:
To ensure patient safety, we recommend making continuous cuff pressure monitoring a routine
practice, given that ETT
cuff pressure may vary depending on the
patient position.
Keywords:
Position, Prone, Supine, Semi
-
Fowler, Endotracheal Cuff Pressure, Sore Throat