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GENERAL ARTICLES

Repeated Deflation of a Gas-Barrier Cuff to Stabilize Cuff Pressure During Nitrous Oxide Anesthesia

Department of Anesthesiology, National Defense Medical College, Tokorozawa, Saitama, Japan

Address correspondence and reprints requests to Fujio Karasawa, MD, Department of Anesthesiology, National Defense Medical College, Tokorozawa, Saitama, 359-8513 Japan. Address e-mail to karasawa{at}me.ndmc.ac.jp

Although a nitrous oxide (N₂O) gas-barrier cuff effectively limits the increase of cuff pressure during N₂O anesthesia, there are few data assessing whether an N₂O gas-barrier cuff is more beneficial for stabilizing intracuff pressure than standard endotracheal tubes when cuffs are repeatedly deflated to stabilize pressure during N₂O anesthesia. In the present study, the pressure of air-filled standard-type cuffs (Trachelon; Terumo, Tokyo, Japan) and N₂O gas-barrier type endotracheal tube cuffs (Profile Soft-Seal Cuff [PSSC]; Sims Portex, Kent, UK) was measured during 67% N₂O anesthesia (n = 8 in each), during which the cuffs were repeatedly deflated every 30 min (Trachelon) or 60 min (PSSC) for the first 3 or 4 h. After aspirating the cuffs for 3 h, the cuff pressure exceeded 22 mm Hg in more than half of the patients in both groups. However, aspiration of the cuffs for 4 h decreased the maximal cuff pressure between deflation intervals in both groups (P < 0.01 for each), and increased the intracuff N₂O concentration (P < 0.0001 for each). After deflating the cuffs over 4 h, the cuff pressure in both groups never exceeded 22 mm Hg during the subsequent 3 h, and intracuff N₂O concentrations did not significantly change. Therefore, deflation of cuffs for 4 h during N₂O anesthesia sufficiently stabilized cuff pressure and equilibrated the intracuff N₂O concentrations in both groups. The use of the PSSC endotracheal tube might be more practical because of the smaller number of cuff deflations required, but the PSSC does not reduce the duration of cuff deflations to stabilize the pressure.

IMPLICATIONS: We demonstrated that the N₂O concentration and pressure in the N₂O-barrier Profile Soft-Seal Cuff stabilized when the cuff was aspirated once an hour for 4 h during N₂O anesthesia. The Profile Soft-Seal Cuff might be easier to use in clinical practice than standard endotracheal tubes because of the smaller number of cuff deflations required.

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