Postoperative Sore throat- comparing Manual Pilot Balloon Palpation and Monitored Endo Tracheal Tube Cuff Pressure Technique:An Analytic Cross Sectional Study
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Date
2020-12
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Addis Abeba University
Abstract
Background:
Postoperative sore throat is one of the most frequently reported symptoms following tracheal
intubation. It has several risk factors that include demographic features as well as clinical
aspects. Two aspects stand out regarding the anesthetic management, endotracheal tube (ETT)
cuff pressure and cuff size. The ideal range for ETT cuff pressures is typically between 20 to 30
cm H2O. Despite this objective measurement of the cuff pressures is not done and professionals
mostly rely on manual methods of estimation, often with less accuracy.
Objective:
The objective of this study was to compare the incidence and severity of post-operative sore throat
in patients when endotracheal cuff pressure will be monitored and adjusted versus the conventional
pilot balloon palpation technique.
Methodology:
The study was conducted at Tikur Anbessa specialized Hospital in Addis Ababa, Ethiopia. A
hospital based analytic cross sectional study was conducted involving 100 patients. Patients 18
years and older scheduled for gastrointestinal, gynecology, thoracic, orthopedic, neurosurgery and
open urology and ENT elective surgery under general anesthesia with ETT at Black lion
specialized hospital between August – November , 2020 were recruited. Patients were grouped in
to two and in the first group patients had their ETTc initially inflated, checked by a cuff pressure
gauge, recorded and then set to 25 cmH2O. In the second group patients had their ETTc inflated
using the pilot balloon palpation method. Patients were then followed up for post-operative sore
throat at 24 hours post-surgery. Bivariate and multivariate logistic regressions were used to
determine the association.
Results: From all of the patients 39(39%) of them had postoperative sore throat within 24 hours.
44% of patients from the manual pilot balloon palpation group had developed Postoperative sore
throat while 34% of participants in the monitored endotracheal tube cuff pressure group had it.
From the total patients 51(51%) were male and 49(49%) were female; majorities of them were
found age between 36-55 and mean age was 44. In terms of patients ASA status most of them
69(69%) were ASA 2 followed by ASA 1 who were 25(25%), rest 6% ASA 3: above half of
patients 72(72%) were laryngoscopic grade1. Majority of surgeries were general surgery
(62%).ETT size 6 was used in sixty seven patients (67%)
Conclusion and Recommendation: Patients in whom endotracheal tube cuff pressure was
measured and adjusted had similar risk of developing postoperative sore throat as compared to
those patients in which manual pilot balloon palpation technique was used. The analysis based on
binary and multiple logistic regression analysis showed that patient age was found to have
significant association with development of POST (p-value 0.038, AOR .141 95% CI (.022, .901)).
A research with a bigger sample size should be conducted on the topic. Also a randomized control
trial can be conducted in the future. Simple yet relatively cheap and effective methods for
continuous monitoring of cuff pressure such as using arterial line transducers can be applied.
Description
Keywords
Postoperative sore throat, balloon palpation , Endo tracheal tube