Johny Pradeesh, Segaran Sivakumar, Vidya Mysore Venkatakrishnan, Zachariah Mamie, Koshy Sagiev George
Department of Anaesthesiology and Critical Care, Pondicherry Institute of Medical Sciences, India.
Turk J Anaesthesiol Reanim. 2022 Aug;50(4):261-266. doi: 10.5152/TJAR.2022.21209.
Cuffed endotracheal tube remains the standard of care during laparoscopic surgeries. Nitrous oxide is widely used as a carrier gas in anaesthesia practice. Cuff pressure greater than 30 cm H2O impairs tracheal mucosal perfusion leading to necrosis. This study aimed to compare the endotracheal tube cuff pressure while using air versus nitrous oxide in the anaesthetic gas mixture during laparoscopic surgeries.
Sixty patients aged 18-70 years undergoing laparoscopic surgery were randomized into 2 groups of 30 each. Group 1 patients received air and oxygen in the anaesthetic gas mixture and group 2 patients received nitrous oxide and oxygen. Cuff pressure changes were measured throughout the surgery and perioperative hemodynamic parameters were recorded. The incidence and severity of postoperative sore throat were also evaluated postoperatively for 24 hours.
The increase in cuff pressure was more in the group using nitrous oxide (40.80 ± 8.78 cm H2O) when compared to the group using air (26.93 ± 2.69 cm H2O) (P < .001). Trendelenburg position was associated with a significant increase in cuff pressure when compared to other positions. The incidence and severity of postoperative sore throat were more at 2 hours (P=.0099) and 4 hours (P=.0105) postoperatively in the group using nitrous oxide. The hemodynamic parameters were comparable between the 2 groups.
The use of nitrous oxide in the anaesthetic gas mixture causes an increase in endotracheal tube cuff pressure and increased severity of postoperative sore throat during laparoscopic surgeries.
带套囊气管内导管仍是腹腔镜手术期间的标准护理措施。氧化亚氮在麻醉实践中广泛用作载气。套囊压力大于30 cm H₂O会损害气管黏膜灌注，导致坏死。本研究旨在比较腹腔镜手术期间在麻醉气体混合物中使用空气与氧化亚氮时的气管内导管套囊压力。
将60例年龄在18至70岁之间接受腹腔镜手术的患者随机分为两组，每组30例。第1组患者在麻醉气体混合物中接受空气和氧气，第2组患者接受氧化亚氮和氧气。在整个手术过程中测量套囊压力变化，并记录围手术期血流动力学参数。术后还对术后24小时内咽痛的发生率和严重程度进行了评估。
与使用空气的组（26.93±2.69 cm H₂O）相比，使用氧化亚氮的组套囊压力升高幅度更大（40.80±8.78 cm H₂O）（P<.001）。与其他体位相比，头低脚高位与套囊压力显著升高相关。使用氧化亚氮的组术后2小时（P=.0099）和4小时（P=.0105）咽痛的发生率和严重程度更高。两组间血流动力学参数具有可比性。
在麻醉气体混合物中使用氧化亚氮会导致腹腔镜手术期间气管内导管套囊压力升高以及术后咽痛严重程度增加。
