Effect of Laryngoscopic Transoesophageal Echocardiography Probe Insertion on Endotracheal Tube Cuff Pressure and Haemodynamics in Oncosurgical Patients: A Randomised Controlled Study

Background: Transoesophageal echocardiography (TOE) is invaluable for haemodynamic monitoring in cardiac patients undergoing non-cardiac surgery. Laryngoscope-guided TOE probe introduction reduces oropharyngeal trauma, odynophagia and the number of attempts. TOE probe placement raises endotracheal tube (ETT) cuff pressure (CP). We aimed to study the effect of laryngoscopic TOE probe insertion on ETT CP, heart rate (HR), mean arterial pressure (MAP) and any TOE-related complications in oncosurgical patients requiring advanced haemodynamic monitoring. Methods: This interventional, randomised controlled study involved 60 adult oncosurgical patients who were randomised into Group T (TOE monitoring) and Group O (no TOE). Our primary outcome measure was CP at temporally corresponding time points in Group T (T 0 – baseline, T 1 – sniffing position, T 2 – laryngoscopy, T 3 – TOE probe insertion, T 4 – laryngoscope removal and T 5 – 10 min post-laryngoscope removal) and Group O (baseline, 1 min, 2 min, 3 min, 5 min and 15 min post-baseline). The secondary outcome measures were HR, MAP, tracheal perfusion pressure and complications [bleed/trauma and post-operative sore throat (POST)] attributable to laryngoscopic TOE placement. Results: The mean ETT CP at T 1 (32.4 cmH 2 O), T 2 (42.1 cmH 2 O), T 3 (53.8 cmH 2 O), T 4 (43.8 cmH 2 O) and T 5 (41.4 cmH 2 O) was significantly ( P < 0.001 for all time points) higher than the baseline CP (corrected to a uniform 24 cmH 2 O in both the groups) for all patients. A statistically significant rise in HR and MAP accompanied laryngoscopic TOE placement ( P < 0.05). There were no complications except for POST (Group T: 22/30; Group O: 2/30 patients). Conclusion: Laryngoscopic TOE probe placement raises CP and causes haemodynamic perturbations in oncosurgical patients. Without corrective measures, POST may commonly ensue. Preventive measures for haemodynamic perturbations during laryngoscopic TOE probe insertion should be instituted.