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The effectiveness of reducing endotracheal cuff pressure after retractor placement to decrease postoperative

Aaron Miller1, Daniel W Griepp1, Chase Miller2

  • 11New York Institute of Technology, Old Westbury, New York.

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|February 16, 2022
PubMed
Summary

Reducing endotracheal tube cuff pressure (ETTCP) after anterior cervical surgery retractor placement may decrease dysphagia and recurrent laryngeal nerve palsy (RLNP) or dysphonia. This evidence supports ETTCP reduction as a protective measure for patients undergoing these procedures.

Keywords:
anterior cervical surgeryendotracheal tube cuff pressurelaryngeal nerve palsypostoperative dysphagiatracheal retraction

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Area of Science:

  • Neurosurgery
  • Anesthesiology
  • Otolaryngology

Background:

  • Anterior cervical fusion surgery often involves retractor placement, potentially leading to laryngeal dysfunction.
  • Endotracheal tube cuff pressure (ETTCP) is a modifiable factor that may influence postoperative outcomes.
  • Laryngeal dysfunction, including recurrent laryngeal nerve palsy (RLNP), dysphagia, and dysphonia, are common complications.

Purpose of the Study:

  • To determine if reducing ETTCP after retractor placement in anterior cervical fusion surgery reduces postoperative laryngeal dysfunction.
  • To achieve consensus on the effectiveness of ETTCP reduction strategies.

Main Methods:

  • A comprehensive literature search was conducted across multiple databases (MEDLINE, EMBASE, Cochrane Central, Google Scholar, Scopus).
  • Quantitative analysis included 9 studies (7 randomized, 1 prospective, 1 retrospective) with 1671 patients comparing reduced vs. unadjusted ETTCP.
  • Outcomes assessed included RLNP, dysphagia, and dysphonia severity and incidence at various postsurgical time points.

Main Results:

  • Reduced ETTCP significantly lowered dysphagia severity at 24 hours and 4-8 weeks.
  • Significantly lower odds of developing dysphonia were observed at 24 hours with reduced ETTCP.
  • Significantly lower odds of RLNP were found at all time points when analyzing combined randomized and observational studies.

Conclusions:

  • Reduction of ETTCP after retractor placement in anterior cervical surgery appears to be a protective measure.
  • This strategy may decrease the severity of dysphagia and the odds of developing RLNP or dysphonia.
  • Current evidence suggests ETTCP reduction is beneficial for mitigating laryngeal dysfunction post-surgery.