This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Web of Science (16) Citing Articles via Google Scholar Google Scholar Articles by Felten, M.-L. Articles by Carli, P. A. Search for Related Content PubMed PubMed Citation Articles by Felten, M.-L. Articles by Carli, P. A. Related Collections Airway Pediatrics

---

PEDIATRIC ANESTHESIA

Endotracheal Tube Cuff Pressure Is Unpredictable in Children

Department of Anesthesia and Critical Care, Centre Hospitalier Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France

Address correspondence and reprint requests to Gilles A. Orliaguet, MD, PhD, Department of Anesthesiology and Critical Care, CHU Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, 149, rue de Sèvres, 75743 Paris Cédex 15, France. Address e-mail to gilles.orliaguet{at}nck.ap-hop-paris.fr

The use of cuffed tracheal tubes in children younger than 8 yr of age has recently increased, although cuff hyperinflation may cause tracheal mucosal damage. In this study, we sought to measure the cuff pressure (P_cuff) after initial free air inflation (iP_cuff) and to follow its evolution throughout the duration of 50% nitrous oxide (N₂O) anesthesia. One-hundred-seventy-four children, aged 0 to 9 yr, fulfilling the following criteria, were studied: 1) weight of 3–35 kg; 2) ASA physical status I or II; 3) elective surgery; 4) anesthesia with tracheal intubation using a cuffed tube and lasting at least 45 min; and 5) gas mixture containing 50% N₂O. Free air inflation results in variable iP_cuff, with hyperinflation in 39% of cases. Numerous gas removals were required to maintain P_cuff less than 25 cm H₂O in 85% of the patients. The number of deflations decreased with the duration of mechanical ventilation and was small after 105 min. No difference was observed among the different cuffed tube sizes. We conclude that iP_cuff is unpredictable after free air inflation and that numerous gas removals are required to maintain P_cuff less than 25 cm H₂O during N₂O anesthesia in children.

IMPLICATIONS: Free inflation of the tracheal tube cuff, controlled only by the palpation of the pilot balloon, is not reliable and results in extremely variable (and sometimes very high) initial cuff pressures in children. In addition, nitrous oxide anesthesia may result in cuff hyperinflation requiring numerous gas removals.