title: Endotracheal cuff pressure changes with change in position in neurosurgical patients.
abstract: BACKGROUND
  Placement of a cuffed endotracheal tube for the administration of general anesthesia is routine. The cuff of the endotracheal tube is inflated with air to achieve an adequate seal to prevent micro-aspiration. Over inflation of the cuff can decrease the mucosal perfusion, leading to pressure necrosis and nerve palsies. Inadequate seal can lead to micro aspiration. So the cuff pressure has to be monitored and kept within the prescribed limits of 20-30 cms of water.
  
  
  OBJECTIVE
  To observe the effect of different positions on the endotracheal cuff pressure in patients undergoing neurosurgical procedures.
  
  
  METHODS
  This is an observational study conducted on 70 patients undergoing neurosurgical procedures in various positions. After intubation, the cuff pressure was checked with a cuff pressure manometer, Endotest (Teleflex Medical, Rush) and adjusted to be within the allowable pressure limits as is the routine practice. The cuff pressure was checked again at three time points after achieving the final position with the head on pins, at the end of the procedure and before extubation. Various factors such as the age, position, duration of surgery were studied. There were no major complications like aspiration, stridor or hoarseness of voice post extubation in any of the patients.
  
  
  RESULTS
  A significant decline in the cuff pressures were noted from the initial supine position to extubation (P < .001) in the supine group. Also a significant decline in the cuff pressures were found in the prone group from their initial intubated supine position to all the other three corresponding time points namely after final positioning (P < .001), at the end of the procedure (P < .001) and before extubation (P < .001).
  
  
  CONCLUSIONS
  Cuff pressure has to be checked after achieving the final positioning of the patient and adjusted to the prescribed limits to prevent micro aspiration.
authors.affiliation: Department of Anesthesiology, Washington University in St. Louis, Missouri, USA.
authors.forename: UmeshKumar
authors.initials: U
authors.lastname: Athiraman
authors.affiliation: Department of Anesthesiology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.
authors.forename: Rohit
authors.initials: R
authors.lastname: Gupta
authors.affiliation: Department of Anesthesiology and Critical Care, Christian Medical College, Vellore, Tamil Nadu, India.
authors.forename: Georgene
authors.initials: G
authors.lastname: Singh
keywords: Different positions; ETT cuff pressure; neurosurgical patients