Kamaladevi Rithu Krishna, Mishra Sandeep Kumar, Rudingwa Priya, Mohapatra Devi Prasad, Badhe Ashok Shankar, Senthilnathan Muthapillai
Department of Anaesthesia and Critical Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Department of Anaesthesia and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.
Paediatr Anaesth. 2024 Apr;34(4):340-346. doi: 10.1111/pan.14837. Epub 2024 Jan 8.
Airway management in children with oral cleft surgery carries unique challenges, concerning the proximity of the surgical site and the tracheal tube. We hypothesized that using a Microcuff oral RAE tube would reduce tube exchange and migration rate. We aimed to compare the performance of Microsoft and uncuffed oral performed tracheal tubes in children undergoing cleft palate surgeries regarding the rate of tracheal tube exchange, endobronchial intubation, and ventilatory parameters.
One hundred children scheduled for cleft palate surgery were randomized into two groups. In the uncuffed group (n = 50), the tracheal tube was selected using the Modified Coles formula, and in the Microcuff (n = 50) group, the manufacturer's recommendations were followed. Intraoperatively, we compared the primary outcome of tube exchange using the chi-square test. The leak pressure and ventilatory parameters after head extension and mouth gag application were measured in both groups.
The tracheal tube exchange rate was significantly lower in the Microcuff group (0/50) than in uncuffed (19/50) preformed tubes (0 vs. 38% respectively; p <.001). The uncuffed and Microcuff tracheal tube were comparable concerning ventilation parameters and leak pressure of finally placed tubes (17.78 ± 3.95 vs. 19.26 ± 3.81 cm H O respectively, with a mean difference (95% CI) of -1.48 (-0.01-2.98); p-value =0.059. Cuff pressure did not vary significantly during the initial hour, and the incidence of postoperative airway morbidity between uncuffed and Microcuff tube was comparable, 5/50 (10%) versus 7/50 (14%) with risk ratio (95% CI) of 0.71(0.24-2.1), p value .49.
Microcuff oral preformed tubes performed better than uncuffed tubes regarding tube exchange during cleft palate surgery.
腭裂手术患儿的气道管理面临独特挑战，涉及手术部位与气管导管的距离。我们假设使用带微型套囊的口腔RAE导管可降低导管更换和移位率。我们旨在比较带微型套囊和无套囊的口腔预制气管导管在腭裂手术患儿中的性能，包括气管导管更换率、支气管内插管率和通气参数。
将100例计划行腭裂手术的患儿随机分为两组。在无套囊组（n = 50），使用改良的科尔斯公式选择气管导管，在带微型套囊组（n = 50），遵循制造商的建议。术中，我们使用卡方检验比较导管更换的主要结果。两组均测量了头部伸展和使用开口器后的漏气压力和通气参数。
带微型套囊组（0/50）的气管导管更换率显著低于无套囊预制导管组（19/50）（分别为0 vs. 38%；p <.001）。无套囊和带微型套囊的气管导管在最终放置导管的通气参数和漏气压力方面具有可比性（分别为17.78±3.95 vs. 19.26±3.81 cm H₂O，平均差（95%CI）为-1.48（-0.01 - 2.98）；p值 = 0.059）。初始1小时内套囊压力无显著变化，无套囊和带微型套囊导管术后气道并发症的发生率具有可比性，分别为5/50（10%）和7/50（14%），风险比（95%CI）为0.71（0.24 - 2.1），p值为0.49。
在腭裂手术中，带微型套囊的口腔预制导管在导管更换方面比无套囊导管表现更好。
