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Changes in gas concentrations in the Brandt endotracheal tube cuff during and after anaesthesia with nitrous oxide

Published online by Cambridge University Press:  30 June 2005

F. Karasawa ,
A. Takita ,
M. Kodama ,
T. Takahashi ,
H. Wada ,
T. Ikemoto  and
T. Satoh
F. Karasawa
Affiliation:
National Defense Medical College, Department of Anaesthesiology, Tokorozawa, Saitama, Japan
A. Takita
Affiliation:
National Defense Medical College, Department of Anaesthesiology, Tokorozawa, Saitama, Japan
M. Kodama
Affiliation:
National Defense Medical College, Department of Anaesthesiology, Tokorozawa, Saitama, Japan
T. Takahashi
Affiliation:
National Defense Medical College, Department of Anaesthesiology, Tokorozawa, Saitama, Japan
H. Wada
Affiliation:
National Defense Medical College, Department of Anaesthesiology, Tokorozawa, Saitama, Japan
T. Ikemoto
Affiliation:
National Defense Medical College, Department of Anaesthesiology, Tokorozawa, Saitama, Japan
T. Satoh
Affiliation:
National Defense Medical College, Department of Anaesthesiology, Tokorozawa, Saitama, Japan
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Extract

Summary

Background and objective: The mechanism underlying stable cuff pressure in the Brandt rediffusion endotracheal tube during anaesthesia with nitrous oxide is not fully understood. The present study assessed changes in gas concentrations in the cuff during and after nitrous oxide anaesthesia.

Methods: The pressure of an air-filled Brandt endotracheal tube cuff was measured; anaesthesia was maintained with nitrous oxide 67% and oxygen 33% for 6 h in the Continuous Group; oxygen was substituted for nitrous oxide after 3 h of nitrous oxide anaesthesia in the Discontinuous Group (n = 8 for each). In some other patients, the study was terminated at 90, 180, 270 and 360 min (n = 8 for each). Gas concentrations in the cuff were measured at the end of the study.

Results: Cuff pressures increased slightly during the first 180 min of anaesthesia (P < 0.001). Thereafter, the cuff pressure did not change significantly in the Control Group but decreased in the Discontinuous Group (P < 0.001); there was a significant difference between the two groups (P < 0.0001). Cuff pressure never exceeded 22 mmHg and there were no air leaks in either group during the 6 h anaesthesia. Nitrous oxide concentrations in the cuff were 11.3 ± 2.6% and 2.6 ± 0.8% in the Control Group and Discontinuous Groups, respectively; however, changes in carbon dioxide and oxygen concentrations in the cuff were within approximately 1%.

Conclusions: Small changes in the nitrous oxide concentration in the cuff contribute to a stable cuff pressure in the Brandt rediffusion system, but changes in carbon dioxide or oxygen concentrations have little effect.

Keywords

ANAESTHETICS, INHALATION, nitrous oxideINTUBATION, intratracheal intubation, intratrachealINTRAOPERATIVE COMPLICATIONS
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 20 , Issue 5 , May 2003 , pp. 391 - 395
Copyright
2003 European Society of Anaesthesiology

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References

Karasawa F, Tokunaga M, Aramaki Y, Shizukuishi M, Satoh T. An assessment of a method of inflating cuffs with a nitrous oxide gas mixture to prevent an increase in intracuff pressure in five different tracheal tube designs apparatus. Anaesthesia 2001; 56: 155–159.Google Scholar
Karasawa F, Ohshima T, Takamatsu I, et al. The effect on intracuff pressure of various nitrous oxide concentrations used for inflating an endotracheal tube cuff. Anesth Analg 2000; 91: 708–713.Google Scholar
Mandoe H, Nikolajsen L, Lintrup U, Jepsen D, Molgaard J. Sore throat after endotracheal intubation. Anesth Analg 1992; 74: 897–900.Google Scholar
Resnikoff E, Katz JA. A modified epidural syringe as an endotracheal tube cuff pressure-controlling device. Anesth Analg 1990; 70: 208–211.Google Scholar
Kin JM. The tracheal tube cuff pressure stabilizer and its clinical evaluation. Anesth Analg 1980; 59: 291–296.Google Scholar
Payne KA, Miller DM. The Miller tracheal cuff pressure control valve. Anaesthesia 1993; 48: 324–327.Google Scholar
Brandt L, Pokar J. The rediffusion system: limitation of nitrous oxide-induced increase of the pressure of endotracheal tube cuff. Anaesthesist 1983; 32: 459–464.Google Scholar
Lomholt N, Borgeskov S, Kirkby B. A new tracheostomy tube III. Bronchofiberoptic examination of the trachea after prolonged intubation with the NL tracheostomy tube. Acta Anaesthesiol Scand 1981; 26: 407–411.Google Scholar
Karasawa F, Mori T, Okuda T, Satoh T. Profile Soft-Seal Cuff, a new endotracheal tube, effectively inhibits an increase in the cuff pressure through high compliance rather than low diffusion of nitrous oxide. Anesth Analg 2001; 92: 140–144.Google Scholar
Fujikawa M, Mizoguchi H, Kawamura J, et al. A new endotracheal tube with a cuff impervious to nitrous oxide: constancy of cuff pressure and volume. Anesth Analg 1995; 81: l084–1086.Google Scholar
Al-Shaikh B, Jones M, Baldwin F. Evaluation of pressure changes in a new design tracheal tube cuff, the Portex Soft Seal, during nitrous oxide anaesthesia. Br J Anaesth 1999; 83: 805–806.Google Scholar
Fill DM, Dosch MP, Bruni MR. Rediffusion of nitrous oxide prevents increases in endotracheal tube cuff pressure. AANA J 1994; 62: 77–81.Google Scholar
Karasawa F, Mori T, Kawatani Y, Ohshima T, Satoh T. Deflationary phenomenon of the nitrous oxide-filled endotracheal tube cuff after cessation of nitrous oxide administration. Anesth Analg 2001: 92: 145–148.Google Scholar
Seegobin RD, Hasselt GL. Endotracheal cuff pressure and tracheal mucosal blood now: endoscopic study of effects of four large volume cuffs. BMJ 1984; 288: 965–968.Google Scholar
Monroe M, Gravenstein N, Saga-Rumley S. Postoperative sore throat: effect of oropharyngeal airway in orotracheally intubated patients. Anesth Analg 1990; 70: 512–526.Google Scholar
Stout DM, Bishop MJ, Dwersteg JF, Cullen BF. Correlation of endotracheal tube size with sore throat and hoarse-ness following general anesthesia. Anesthesiology 1987; 67: 419–421.Google Scholar
Loeser EA, Kaminsky A, Diaz A, Stanley TH, Pace NL. The influence of endotracheal tube cuff design and cuff lubricant on postoperative sore throat. Anesthesiology 1983; 58: 376–379.Google Scholar