Choi Hey Ran, Kim Seunghwan, Kim Hyo-Jin, Ahn Eun-Jin, Kim Kyung Woo, Bang Si Ra
Inje University Seoul Paik Hospital, Department of Anesthesiology and Pain Medicine, Seoul, Coreia.
Chung-Ang University College of Medicine, Chung-Ang University Medical Center, Department of Anesthesiology and Pain Medicine, Seoul, Coreia.
Braz J Anesthesiol. 2020 Nov-Dec;70(6):583-587. doi: 10.1016/j.bjan.2020.04.021. Epub 2020 Nov 18.
Several airway complications can occur during shoulder arthroscopy including airway obstruction, pleural puncture, and subcutaneous emphysema. It was hypothesized that the irrigation fluid used during a shoulder arthroscopic procedure might increase the cuff pressure of the endotracheal tube, which can cause edema and ischemic damage to the endotracheal mucosa. Therefore, this study aimed to evaluate the relationship between irrigation fluid and endotracheal tube cuff pressures.
Forty patients aged 20 to 70 years with an American Society of Anesthesiologists (ASA) score I or II, scheduled for elective arthroscopic shoulder surgery under general anesthesia, participated in our study. We recorded endotracheal tube cuff pressures and neck circumferences every hour from the start of the operation. We also recorded the total duration of the anesthesia, operation, and the total volume of fluid used for irrigation.
A positive correlation was shown between endotracheal tube cuff pressures and the amount of irrigation fluid (r = 0.385, 95% CI 0.084 to 0.62, = 0.0141). The endotracheal tube cuff pressure significantly increased at 2 and 3 hours after starting the operation ( = 0.0368 and = 0.0245, respectively). However, neck circumference showed no significant difference.
Endotracheal tube cuff pressures increased with operation time and with increased volumes of irrigation fluid used in patients who underwent shoulder arthroscopy. We recommend close monitoring of endotracheal tube cuff pressures during shoulder arthroscopy, especially during long operations using a large amount of irrigation fluid, to prevent complications caused by raised cuff pressures.
肩关节镜检查过程中可能会出现多种气道并发症，包括气道梗阻、胸膜穿刺和皮下气肿。据推测，肩关节镜手术中使用的冲洗液可能会增加气管内导管的套囊压力，进而导致气管黏膜水肿和缺血性损伤。因此，本研究旨在评估冲洗液与气管内导管套囊压力之间的关系。
40例年龄在20至70岁之间、美国麻醉医师协会（ASA）分级为I或II级、计划在全身麻醉下进行择期肩关节镜手术的患者参与了本研究。从手术开始每小时记录一次气管内导管套囊压力和颈围。我们还记录了麻醉、手术的总时长以及冲洗所用液体的总量。
气管内导管套囊压力与冲洗液量之间呈正相关（r = 0.385，95%可信区间为0.084至0.62，P = 0.0141）。手术开始后2小时和3小时气管内导管套囊压力显著升高（分别为P = 0.0368和P = 0.0245）。然而，颈围无显著差异。
在接受肩关节镜检查的患者中，气管内导管套囊压力随手术时间和冲洗液用量的增加而升高。我们建议在肩关节镜检查期间，尤其是在使用大量冲洗液的长时间手术过程中，密切监测气管内导管套囊压力，以预防因套囊压力升高引起的并发症。
