Changes in Endotracheal Cuff Pressure During Positioning From Supine to Beach Chair in Shoulder Surgery: A Prospective Case Series

Introduction Changes in a patient's position from supine to upright may alter the forces exerted by the endotracheal tube (ETT) on the larynx and potentially increase intracuff pressure. This study aimed to investigate whether positional changes from the supine to the beach chair position lead to an increase in intracuff pressure. Additionally, we examined whether the intracuff pressure, when the cuff is inflated using an air syringe, is within the recommended safe range (20-30 cm H₂O) both in the supine position after intubation and after transitioning to the beach chair position. Case presentation This prospective case series enrolled nine patients scheduled for elective shoulder surgery in the beach chair position between July 1 and 31, 2024. All patients received general anesthesia, and tracheal intubation was performed using a high-volume, low-pressure cuff ETT. Immediately after intubation, the ETT cuff was inflated using a syringe with air, guided by manual palpation of the pilot. A member of the research team measured the cuff pressure using a manometer following the initial inflation and again after the patient was repositioned into the beach chair position, immediately before surgical prepping. In both instances, the pressure was adjusted to 30 cm H₂O. Data are reported as median (25th percentile, 75th percentile). Results The median age of the patients was 65 (61, 75) years. Initial intracuff pressures exceeded 30 cm H₂O in all nine patients, with a mean of 73 cm H₂O and a median of 60 cm H₂O (60, 100). After adjustment of the cuff pressure to 30 cm H₂O and the patient seated up, the mean intracuff pressure did not differ significantly from 30 cm H₂O (99% CI 21-46, p = 0.35). Conclusion Changing the patient's position from supine to beach chair had a negligible effect on intracuff pressure. Similar to earlier studies, we observed that using a syringe and manual palpation often resulted in cuff overinflation (>30 cm H₂O) in many patients. We recommend the routine use of a manometer to check ETT cuff pressure, particularly in prolonged cases, to reduce the risk of laryngeal complications.