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Changes in uncuffed endotracheal tube leak during laparoscopic inguinal herniorrhaphy in children
Akiko Noguchi1, Kumiko Kuga2, Naoki Tashiro3
1Department of Anesthesiology and Critical Care Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, Saga, 849-8501, Japan. anoguchi0412@yahoo.co.jp.
Insights
Uncuffed endotracheal tube (ETT) leak decreased during laparoscopic surgery with pneumoperitoneum. Leak pressure increased, indicating a tighter seal in pediatric patients undergoing inguinal herniorrhaphy.
Area of Science:
- Anesthesiology
- Pediatric Surgery
Background:
- Laparoscopic surgery requires pneumoperitoneum, which can affect airway pressures.
- Uncuffed endotracheal tubes (ETT) are used in pediatric patients, and their leak characteristics are important for airway management.
Purpose of the Study:
- To investigate changes in uncuffed ETT leak and leak pressure during laparoscopic inguinal herniorrhaphy in pediatric patients.
Main Methods:
- 31 pediatric patients (1-6 years) undergoing elective laparoscopic inguinal herniorrhaphy were studied.
- Endotracheal tube leak was calculated using tidal volumes (TVi, TVe) at baseline, pre-surgery, post-pneumoperitoneum, and post-surgery.
- Leak pressure was assessed at the same time points.
Main Results:
- Uncuffed ETT leak significantly decreased after pneumoperitoneum induction (T3 vs. T1).
- Leak pressure significantly increased after pneumoperitoneum (T3) and at the end of surgery (T4) compared to baseline (T0).
Conclusions:
- Pneumoperitoneum in pediatric laparoscopic surgery may reduce uncuffed ETT leak.
- Increased leak pressure suggests a tighter seal, but further studies are needed to confirm clinical significance and universality.
Abstract:
The present study was conducted to investigate changes in uncuffed endotracheal tube (ETT) leak during laparoscopic surgery. The study included 31 patients aged between 1 and 6 years scheduled for elective laparoscopic inguinal herniorrhaphy. Inspiratory and expiratory tidal volumes (TVi and TVe) were measured during mechanical ventilation, and ETT leak was calculated using the formula-ETT leak = (TVi - TVe)/TVi × 100 (%), assessed at the following time-points-5 min after the start of mechanical ventilation (T1, baseline), just before the start of surgery (T2), 5 min after the induction of pneumoperitoneum with 15° Trendelenburg tilt (T3), and at the end of surgery (T4). Additionally, leak pressure was assessed after successful tracheal intubation (T0, baseline) at T2, T3 and T4. Uncuffed ETT leak significantly decreased at T3 compared with T1 (baseline). Leak pressure significantly increased at T3 and T4 compared with T0 (baseline). Further studies are needed in order to determine whether the results are universal and associated with clinically significant outcomes.
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