Evaluation of Factors Affecting Changes in Endotracheal Cuff Pressures During Laparoscopic Bariatric Surgery

BACKGROUND Tracheal tube cuff pressure exceeding mucosal perfusion pressure during surgery is associated with complications such as sore throat, mucosal ulcers, rupture, and subglottic stenosis. This study aimed to evaluate factors affecting changes in endotracheal cuff pressures in 27 patients during laparoscopic bariatric surgery and their relationship to surgical stages and airway pressures. MATERIAL AND METHODS A prospective, observational study was conducted on 27 patients, and data were collected on endotracheal cuff pressures, airway pressures, intra-abdominal pressures, respiratory rates, surgical table tilt, and patient demographics. The surgical procedure was divided into 4 stages: (1) pre-abdominal insufflation, (2) abdominal insufflation, (3) surgical table positioning, and (4) peritoneal exsufflation. Patients' perioperative findings were evaluated. RESULTS The mean age of the patients was 36.14±9.46 years, and 92.59% of patients had overinflated cuffs after intubation. Endotracheal tube cuff pressures varied significantly throughout the surgical phases. Before peritoneal insufflation, the mean (SD) cuff pressure was 28.66 (1.41) cmH₂O. This increased significantly during peritoneal insufflation to 41.59 (6.43) cmH₂O. Following the application of the reverse Trendelenburg position, the cuff pressure decreased to 37.11 (5.63) cmH₂O, and after peritoneal deflation, it returned to 29.81 (5.41) cmH₂O (P<0.0001). Multilevel mixed regression analysis revealed that cuff pressure changes were significantly associated with surgical phases (P<0.001) but not with surgical duration or peak airway pressure. CONCLUSIONS Based on the results of our study, endotracheal cuff pressures change significantly during laparoscopic bariatric surgery. Routine monitoring may help clinicians manage patients to minimize postoperative complications.