Variations in Endotracheal Tube Cuff Pressure during Laparoscopic Surgery in Head-Up and Head-Down Positions

Abstract

This study evaluates the changes in endotracheal tube (ETT) cuff pressure during laparoscopic surgeries, specifically comparing the head-up and head-down positions. Laparoscopic procedures require the creation of a pneumoperitoneum, which, combined with patient positioning, can affect respiratory mechanics and alter cuff pressure. Maintaining optimal ETT cuff pressure (20-30 cm H2O) is crucial for preventing complications such as mucosal ischemia or aspiration. This prospective observational study was conducted at ESIC-Medical College-PGIMSR Bangalore from March 2021 to August 2022. A total of 70 patients (35 in the head-up group and 35 in the head-down group) undergoing elective laparoscopic surgery under general anesthesia were included. ETT cuff pressure, intra-abdominal pressure, and peak airway pressure were measured at various time points, including post-insufflation and throughout the procedure. The results demonstrated that ETT cuff pressure increased significantly in the head-down position, with pressures reaching 32.57 ± 1.07 cm H2O at the 60-minute mark, compared to 31.22 ± 1.56 cm H2O in the head-up position (p = 0.012). However, changes in intra-abdominal pressure and peak airway pressure were not statistically significant between the groups. These findings suggest that patient positioning, particularly in the head-down position, plays a critical role in increasing ETT cuff pressure during laparoscopic surgeries. Careful monitoring and adjustment of cuff pressure are essential to prevent airway complications.