The effect of change in position and carbon dioxide insufflation on trached tube cuff pressure during laparoscopic surgeries.

In general anaesthesia patients are intubated with an endotracheal tube during controlled ventilation. In laproscopic surgeries a pneumoperitoneum is created by insufflating gas into the patients’ abdominal cavity. Various factors such as change in position of patient during surgery, cuff volume, use of nitrous oxide, temperature and high altitude affect the endotracheal tube cuff pressure.In our study we have observed the changes in endotracheal tube cuff pressure and airway pressures tube in laparoscopic surgeries in trendelenberg position and their corelation with post operative laryngotracheal morbidity, in an attempt to improve patient recovery in the immediate post operative period.
We observed increased cuff pressures and airway pressures increased at intubation which further increased at abdominal insufflation and head down position peaking at 15 minutes after positional changes. There was no further increase thereafter till the end of the surgery.
The incidence of sore throat, hoarseness and stridor 2 hours post operatively is 86%, 66% and 18% which reduces to 22%, 4% and 0% 24 hours post operatively, respectively. Hence post-operative sore throat was the most common laryngotracheal morbidity followed by hoarseness of voice. In conclusion, monitoring and adjustment of endotracheal tube cuff pressures within the recommended safe limits (25-40 cm H20) intra-operatively will help reduce post-operative laryngotracheal moribidity and increase patient comfort and recovery in the immediate post operative period.