title: Changes in endotracheal tube cuff pressure during laparoscopic surgery in head-up or head-down position.
abstract: BACKGROUND
  The abdominal insufflation and surgical positioning in the laparoscopic surgery have been reported to result in an increase of airway pressure. However, associated effects on changes of endotracheal tube cuff pressure are not well established.
  
  
  METHODS
  70 patients undergoing elective laparoscopic colorectal tumor resection (head-down position, n = 38) and laparoscopic cholecystecomy (head-up position, n = 32) were enrolled and were compared to 15 patients undergoing elective open abdominal surgery. Changes of cuff and airway pressures before and after abdominal insufflation in supine position and after head-down or head-up positioning were analysed and compared.
  
  
  RESULTS
  There was no significant cuff and airway pressure changes during the first fifteen minutes in open abdominal surgery. After insufflation, the cuff pressure increased from 26 ± 3 to 32 ± 6 and 27 ± 3 to 33 ± 5 cmH2O in patients receiving laparoscopic cholecystecomy and laparoscopic colorectal tumor resection respectively (both p < 0.001). The head-down tilt further increased cuff pressure from 33 ± 5 to 35 ± 5 cmH2O (p < 0.001). There six patients undergoing colorectal tumor resection (18.8%) and eight patients undergoing cholecystecomy (21.1%) had a total increase of cuff pressure more than 10 cm H2O (18.8%). There was no significant correlation between increase of cuff pressure and either the patient's body mass index or the common range of intra-abdominal pressure (10-15 mmHg) used in laparoscopic surgery.
  
  
  CONCLUSIONS
  An increase of endotracheal tube cuff pressure may occur during laparoscopic surgery especially in the head-down position.
authors.affiliation: Department of Anesthesiology, National Taiwan University Hospital, No.7, Zhongshan S. Rd. Zhongzheng Dist, Taipei City 10002, Taiwan.
authors.forename: Chun-Yu
authors.initials: CY
authors.lastname: Wu
authors.affiliation: Department of Anesthesiology, National Taiwan University Hospital, No.7, Zhongshan S. Rd. Zhongzheng Dist, Taipei City 10002, Taiwan.
authors.forename: Yu-Chang
authors.initials: YC
authors.lastname: Yeh
authors.affiliation: Department of Anesthesiology, National Taiwan University Hospital, No.7, Zhongshan S. Rd. Zhongzheng Dist, Taipei City 10002, Taiwan.
authors.forename: Ming-Chu
authors.initials: MC
authors.lastname: Wang
authors.affiliation: Department of Anesthesiology, National Taiwan University Hospital, No.7, Zhongshan S. Rd. Zhongzheng Dist, Taipei City 10002, Taiwan.
authors.forename: Chia-Hsin
authors.initials: CH
authors.lastname: Lai
authors.affiliation: Department of Anesthesiology, National Taiwan University Hospital, No.7, Zhongshan S. Rd. Zhongzheng Dist, Taipei City 10002, Taiwan.
authors.forename: Shou-Zen
authors.initials: SZ
authors.lastname: Fan
mesh_terms: D000328:Adult; D000368:Aged; D000403:Airway Resistance; D000769:Anesthesia, Inhalation / Q000379:methods*; D015992:Body Mass Index; D005260:Female; D006257:Head; D018475:Head-Down Tilt; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D056888:Patient Positioning; D011312:Pressure; D011446:Prospective Studies
keywords: Endotracheal tube cuff pressure; Head-down position; Head-up position; Laparoscopic surgery