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Oral Preformed Tracheal Tube- Uncuffed products available at low cost Nexgen Medical Online store, Be used for oral intubationResponsive pilot balloons, Bull-nose tips, Split-resistant radiopaque lines, Smooth Murphy eye, Kink-resistant thermosensitive tubes For more info visit Company website URL Nexgen Medical.

Abstract

Oral Preformed Tracheal Tube The aim of this study is to compare endotracheal tube leak, tube selection, mechanical ventilation, and side effects in the use of uncuffed tubes in both laparoscopic and laparotomy surgeries in pediatric patients. Material and Method. Patients who underwent laparotomy (LT group) or laparoscopic (LS group) surgery between 1 and 60 months. In the selection of uncuffed tubes, it was also planned to start endotracheal intubation with the largest uncuffed tube and to start intubation with a small uncuffed tube if the tube encounters resistance and does not pass. Mechanical parameters, endotracheal tube size, tube changes, and side effects are recorded. Results. A total of 102 patients, 38 females and 64 males, with a mean age of months, body weight, and height, were included. 54 patients underwent laparoscopic surgery, and 48 patients underwent laparotomy. Tube exchange was performed in a total of 18 patients. In patients who underwent tube exchange, 11 patients were intubated with a smaller ETT number and others endotracheal intubation; when the MV parameters were and, a larger uncuffed tube was used due to PIP 30 cmH₂O pressure. Patients with aspiration were not found in the LT and LS groups. There was no difference in the intergroup evaluation for postoperative side effects such as cough, laryngospasm, stridor, and aspiration. Conclusion. There was no significant difference between the groups in terms of tube changes and side effects. So that we can start with the largest possible uncuffed tube to decrease ETT leak, both laparotomy and laparoscopic operations in children can be achieved with safe mechanical ventilation and target tidal volume.

1. Introduction

There is a widespread opinion that an uncuffed endotracheal tube (ETT) should be selected as the intubation tube in pediatric patients [1–4]. Despite disadvantages such as air leakage, environmental contamination of anesthetic gases, and aspiration, the application of an uncuffed ETT prevents trauma to the subglottic region in childhood; moreover, a lower airway is often preferred for many reasons, such as the application of resistance [1, 2, 4, 5]. In addition, if the uncuffed ETT is not of a suitable size, the ETT leakage rate increases; this can create problems in reaching target tidal volumes in mechanical ventilation [4, 6]. Therefore, to reduce the risk of aspiration in laparoscopic surgery, to prevent multiple laryngoscopies and intubations, and for more accurate monitoring of tidal volume and end-tidal carbon dioxide in ventilation, a cuffed ETT is also used [1, 3]. However, the cricoid of the tracheal tubes poses a serious risk of airway damage in children due to the cuff being inserted between the subglottic region and the vocal cords and due to the fact that all pediatric cuffed tubes have the main design defects that can cause airway complications [4, 6–9]. Today, preference is given according to the advantages and disadvantages of ETT in pediatric patients; however, there are still no precise rules. In the literature, there are no reports of previous studies evaluating the use of cuffed vs. uncuffed ETT in pediatric patients under the age of 5 years in both laparotomy and laparoscopic surgeries. The aim of this investigation is to assess whether there is a relationship between the use of perioperative mechanical ventilation management and the frequency of development of complications.

2. Methods

Patients who underwent laparotomy (LT group) or laparoscopic (LS group) surgery between 1 and 60 months after receiving hospital ethics committee approval and who underwent uncuffed ETT during intubation were retrospectively included in the study. Patients with neuromuscular or congenital metabolic diseases of childhood, asthma and other lung diseases, intubation with a cuffed ETT, a difficult airway in a mask or intubation, postoperative intubation in the case of need, or tracheostomy were excluded from the study. All patients received premedication with oral midazolam 0.5 mg/kg at least 30 minutes before induction of general anesthesia. Intraoperative monitoring was provided with heart rate, noninvasive blood pressure, peripheral oxygen saturation, and capnography. The induction of general anesthesia was achieved with 5-8% sevoflurane (Sevorane®; Abbott Ltd., UK), 50% oxygen, 50% air, 1 μg/kg remifentanil (Rentanil®; Vem Ltd., Ankara, Turkey), and 0.45 mg/kg rocuronium bromide (Myocron®; Vem Ltd., Ankara, Turkey) in all children. The intubation was performed by the experienced anesthesiologist, who had >10 years of experience in pediatric anesthesia. The size of the uncuffed ETT (Chilecom®; Wellkang Ltd., London, UK) was formulated based on the internal diameter (ID) in mm:  (Penlington’s formula). Tube selection was carried out so as to start endotracheal intubation with the largest uncuffed tube and continue intubation with a smaller uncuffed tube if the tube encountered resistance and could not pass. After the position of the tube was confirmed by auscultation, capnography, and , tube detection was performed. After intubation, all patients underwent gastric decompression with a nasogastric tube followed by mechanical ventilation in pressure control ventilation (PCV) mode (Avance CS²®; Datex Ohmeda, Madison WI, USA). Respiration parameters such as end-tidal carbon dioxide (etCO₂), peak inspiratory pressure (PIP), inspiration tidal volume (TVi), and expiration tidal volume (TVe) of all preoperative and perioperative patients were measured through a flow sensor connected between the ETT and the ventilator circuit. Mechanical ventilation (MV) settings were adjusted to PIP 10-30 cmH₂O, TVA 8-10 ml/kg, inspiration : expiration ratio 1 : 2, and positive end-expiratory pressure (PEEP) 5 cmH₂O. The number of inhalations was adjusted within the limits of etCO₂ 25-40 mmHg. The value of the ETT leak was calculated  [6,8]. A larger number tube size was decided by the attending anesthetist and was based on the existence of  or  or  in the MV. Pneumoperitoneum was induced by insufflating carbon dioxide (CO₂) into the abdomen with the intra-abdominal pressure maintained at 10-11 mmHg (Electronic Endoflator; Karl-Storz, Tuttlingen, Germany), with the patient’s position recorded as flank, supine, lithotomy position, or 0-25° reverse Trendelenburg tilt. After pneumoperitoneum, TVe was adjusted to 8-10 ml/kg and etCO₂ to 25-40 mmHg, gradually increasing the values of PIP and respiration. After intraoperative or pneumoperitoneum and in the case of less than 8 ml/kg etCO₂ over 40 mmHg, manual ventilation was changed from PCV mode, and etCO₂ was reduced below 40 mmHg. In the maintenance of anesthesia, 4 l/min, 50% oxygen, and air, 2%-4% sevoflurane (MAC 1-1.3), and remifentanil 0.05-0.2 μg/kg/min were provided. The sexes of patients, age, body weight, height, ASA, operation, tube change, number of breaths, PIP, peripheral oxygen saturation (spO₂), respiratory count, etCO₂, duration of operation, additional drugs, ETT numbers, and tube changes were recorded. In addition, coughing, laryngospasm, or stridor at extubation was recorded. Demographic data, ventilation parameters (breath rate, PIP, and etCO₂), size of ETT, the reason for tube change, aspiration, coughing, laryngospasm, or stridor were recorded.

2.1. Statistical Analysis

Data were analyzed by using the SPSS 23 package program for Windows. While evaluating the study data, descriptive statistics were presented as mean and standard deviation. Comparison of quantitative data between groups was done by the Mann−Whitney test. Comparison of categorical variables between groups was done by the chi-squared test; continuous variables with a normal distribution were evaluated by using one-way analysis of variance, Oral Preformed Tracheal Tube while continuous variables with a nonnormal distribution were evaluated by using Kruskal-Wallis variance analysis. Statistical significance was evaluated at the level of.

3. Results

A total of 102 patients, 38 females and 64 males, with a mean age of months, body weight, and height, Oral Preformed Tracheal Tube were included (Table 1). Surgical applications included acute abdominal surgery, ectopic testicle exploration, inguinal hernia repair, pyeloplasty, renal mass, colostomy opening or closing, and acute abdominal expression. Hirschsprung pull-through, Nissen fundoplication, liver biopsy, and cholangiography were used (Table 2)