title: Changes in intracuff pressure of cuffed endotracheal tubes while positioning for adenotonsillectomy in children.
abstract: BACKGROUND
  When using cuffed endotracheal tubes (cETTs), changes in head and neck position can lead to changes in intracuff pressure.
  
  
  OBJECTIVE
  The aim of this study was to assess the combined effect of neck extension, shoulder roll placement, and Crowe-Davis retractor use during adenotonsillectomy on the intracuff pressure of cETTs in children.
  
  
  METHODS
  Patients <18 years of age undergoing adenotonsillectomy under general anesthesia following the placement of a cETT were included in the study. After inflation of the cuff to seal the trachea, using the leak test, baseline intracuff pressure was recorded and then continuously monitored. After neck extension, placement of a shoulder roll, insertion of the Crow-Davis retractor, suspension from a Mayo stand, and positioning for surgery, the intracuff pressure was recorded again.
  
  
  RESULTS
  The study cohort included 84 patients, ranging in age from 0.9 to 17 years (5.7 ± 3.9 years). In 46 patients (54.8%), the intracuff pressure increased from baseline after positioning for adenotonsillectomy. In 12 of these patients (14.3%), the intracuff pressure was >30 cm H2O. The intracuff pressure decreased in 28 patients (33.3%), while no change was noted in 10 patients (11.9%). Overall, the general trend was an increase in intracuff pressure from 15.9 ± 7.8 cm H2O to 18.9 ± 11.6 cm H2O.
  
  
  CONCLUSIONS
  Both increases and decreases in the intracuff pressure may occur following positioning of the pediatric patient for adenotonsillectomy. An increase in intracuff pressure may result in a higher risk of damage to the tracheal mucosa. A decrease in the intracuff pressure can result in an air leak resulting in inadequate ventilation, increased risk of aspiration, and even predispose to airway fire if oxygen-enriched gases are used. Continuous intracuff pressure monitoring or rechecking the intracuff pressure after positioning for adenotonsillectomy may be indicated.
authors.affiliation: The Ohio State University College of Medicine, Columbus, OH, USA.
authors.forename: Griffin H
authors.initials: GH
authors.lastname: Olsen
authors.affiliation: Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.|Department of Anesthesiology & Pain Medicine, The Ohio State University College of Medicine, Columbus, OH, USA.
authors.forename: Senthil G
authors.initials: SG
authors.lastname: Krishna
authors.affiliation: Department of Otolaryngology and Head & Neck Surgery, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA.
authors.forename: Kris R
authors.initials: KR
authors.lastname: Jatana
authors.affiliation: Department of Otolaryngology and Head & Neck Surgery, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA.
authors.forename: Charles A
authors.initials: CA
authors.lastname: Elmaraghy
authors.affiliation: Department of Otolaryngology and Head & Neck Surgery, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA.
authors.forename: James M
authors.initials: JM
authors.lastname: Ruda
authors.affiliation: Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.|Department of Anesthesiology & Pain Medicine, The Ohio State University College of Medicine, Columbus, OH, USA.
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Tobias
mesh_terms: D000233:Adenoidectomy / Q000295:instrumentation* / Q000379:methods; D000293:Adolescent; D000768:Anesthesia, General; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007223:Infant; D007442:Intubation, Intratracheal / Q000295:instrumentation* / Q000379:methods; D008297:Male; D056888:Patient Positioning / Q000379:methods*; D011229:Preanesthetic Medication; D011312:Pressure; D011446:Prospective Studies; D014068:Tonsillectomy / Q000295:instrumentation* / Q000379:methods
keywords: adenotonsillectomy; cuffed endotracheal tube; intracuff pressure