Janani S R, Masapu Dheeraj, Dhananjay D N, Rudrappa Satish, Govindasamy Ramachandran, Jagadish T
Department of Neuroanaesthesia and Neurocritical Care, National Institute of Mental Health and Neuro Science (NIMHANS), Bangalore, Karnataka, India.
Division of Neuroanaesthesia, Aster International Institute of Neurosciences and Spine Care, Aster Whitefield Hospital, Bangalore, Karnataka, India.
Indian J Anaesth. 2025 Jul;69(7):675-680. doi: 10.4103/ija.ija_1046_24. Epub 2025 Jun 12.
This randomised study investigated whether microcuff endotracheal tubes (ETT) reduce postoperative complications compared to wire-reinforced ETT in patients undergoing anterior cervical discectomy and fusion (ACDF).
In total, 120 patients were randomly assigned to receive either a microcuff ETT (Group M) or a wire-reinforced ETT (Group W) during surgery. Intraoperative cuff pressure changes due to retractor use were noted. Postoperative complications such as vocal cord palsy and airway oedema were observed at extubation, and hoarseness, sore throat, dysphagia, and stridor were assessed at 6, 24, and 48 hours after extubation. Data were analysed using SPSS v. 24 software. The sample size was calculated from a study based on the primary outcome, which is hoarseness of voice, to detect a 16% difference between the two groups, with 80% power and a significance level of < 0.05.
Both groups had similar baseline characteristics. The initial and post-retraction cuff inflation volumes were significantly lower in Group M. Cuff pressure increased significantly after retractor use in both groups ( < 0.001), with a greater increase observed in Group W. While no patient experienced stridor, vocal cord palsy, or airway oedema, the incidence of postoperative hoarseness was significantly lower in Group M (16.6% vs 6.7%) ( = 0.040). There were no significant differences in the rates of sore throat or dysphagia.
Microcuff ETT may offer advantages over wire-reinforced ETT during ACDF by potentially reducing the incidence of hoarseness, likely due to lower cuff pressure with preserved tracheal mucosal perfusion, and requiring less readjustment of the cuff after retractor application.
本随机研究调查了在接受颈椎前路椎间盘切除融合术（ACDF）的患者中，与钢丝加强型气管内导管（ETT）相比，微囊气管内导管是否能减少术后并发症。
总共120例患者在手术期间被随机分配接受微囊气管内导管（M组）或钢丝加强型气管内导管（W组）。记录使用牵开器时术中气囊压力的变化。在拔管时观察术后并发症，如声带麻痹和气道水肿，并在拔管后6、24和48小时评估声音嘶哑、咽痛、吞咽困难和喘鸣。使用SPSS v. 24软件进行数据分析。样本量是根据一项基于主要结局（即声音嘶哑）的研究计算得出的，以检测两组之间16%的差异，检验效能为80%，显著性水平<0.05。
两组具有相似的基线特征。M组初始和牵开器使用后的气囊充气量显著更低。两组在使用牵开器后气囊压力均显著增加（<0.001），W组增加幅度更大。虽然没有患者出现喘鸣、声带麻痹或气道水肿，但M组术后声音嘶哑的发生率显著更低（16.6%对6.7%）（=0.040）。咽痛或吞咽困难的发生率没有显著差异。
在ACDF手术中，微囊气管内导管可能比钢丝加强型气管内导管更具优势，可能是因为其气囊压力较低，能保持气管黏膜灌注，从而有可能降低声音嘶哑的发生率，并且在使用牵开器后需要更少的气囊重新调整。
