A comparative analysis of elevated endotracheal tube cuff pressure incidence in laparoscopic abdominal surgery: saline versus air inflation

BACKGROUND: Endotracheal intubation is a frequently performed procedure in anesthesia practice, and ensuring the correct inflation of the cuff is essential for maintaining the airway seal. Overinflation of endotracheal tube (ETT) cuffs can lead to complications, such as postoperative sore throat. This study aimed to compare the incidence of elevated ETT cuff pressure between saline and air inflation in elective laparoscopic abdominal surgery. METHODS: The study involved 60 participants ranging in age from 18 to 65, with American Society of Anesthesiologists physical status levels 1-2, who underwent laparoscopic abdominal surgery. We randomly assigned patients to two groups: Group A (air-filled ETT cuffs, N.=30) and Group S (saline-filled ETT cuffs, N.=30). Intra-cuff pressure was recorded before and after CO2 2 insufflation, as well as during changes in patient position. The number of interventions to restore intra-cuff pressure to 18 mmHg was documented. Peak airway pressure, plateau pressure, and positive end- expiratory pressure (PEEP) were measured at 15-minute intervals. RESULTS: The number of interventions needed to maintain intra-cuff pressure was significantly lower in the saline group compared to the air group. All patients started with initial cuff pressures above 20 mmHg. After insufflation, the first- minute cuff pressures were higher in the air group (P=0.001). Both groups experienced a significant increase in intra-cuff pressure with the Trendelenburg position, and after moving to the reverse Trendelenburg position (saline and air groups, P=0.001 and 0.012, respectively), the air group had higher intra-cuff pressure than the saline group (P=0.002). There were no significant differences between groups in peak airway pressure, plateau pressure, and PEEP. CONCLUSIONS: Inflating ETT cuffs with saline instead of air during laparoscopic abdominal surgeries led to a reduced requirement for interventions in maintaining pressure. This indicates that the use of saline inflation may significantly lower the risk of high cuff pressure and related complications.