Comparison of the cuff pressures of a TaperGuard endotracheal tube during ipsilateral and contralateral rotation of the head: A randomized prospective study

BACKGROUND: Maintaining optimal intracuff pressure of the endotracheal tube is important during airway management. Rotation of the head can affect the cuff pressure of the endotracheal tube. We investigated the change in cuff pressure and the degree of tube displacement according to the direction of head rotation (toward the same side vs opposite side of tube fixation) using a TaperGuard endotracheal tube. METHODS: We conducted a prospective study in 58 patients, aged 18 to 70 years, who underwent tympanomastoidectomy under general anesthesia. TaperGuard endotracheal tube was secured at the corner of the mouth, either on the same side as that of the head rotation (Group S, n = 29) or on the opposite side (Group O, n = 29). After endotracheal intubation, the endotracheal tube cuff pressure was set at 22 cmH(2)O in the neutral position of the head. The cuff pressure was measured again after lateral rotation of the head and readjusted to 22 cmH(2)O. In addition, the change in distance from the carina to the tip of the endotracheal tube was measured before and after the change in position. The incidences of cough, sore throat, and hoarseness were assessed at 30 minutes, 6 hours, and 24 hours after surgery. RESULTS: There were no differences between groups in terms of patient characteristics and duration of anesthesia. The change in cuff pressure after head rotation in Group S (8.07 ± 1.07 cmH(2)O) was greater than that in Group O (2.24 ± 0.95 cmH(2)O) (P < .001). In addition, 21 (72.4%) patients in Group S and no patient in Group O had pressures above 30 cmH(2)O (P < .001). Furthermore, the tube tip moved away from the carina by 8.55 ± 7.01 mm in Group S and by 2.83 ± 4.72 mm in Group O (P < .001). CONCLUSION: Fixation of the TaperGuard endotracheal tube on the side contralateral to head rotation was associated with a smaller intracuff pressure increase and lesser tube displacement compared to fixation of the tube on the ipsilateral side.