Abstract No.: ABS1770: Cuffed versus uncuffed endotracheal tubes in infants undergoing elective surgery in prone position:peritubal leak at standardised ventilator settings

BACKGROUND & AIMS: The purpose of this study was to compare peritubal leak in cuffed and uncuffed tubes in infants at standardised ventilatorsettings. Secondary objective was to see incidence of accidental extubation and postoperative respiratory complications such as stridor and sore throat. METHODS: With ethics committee approval, a prospective,randomised,clinical study was conducted. Patients aged between birth to 1 year, American Society of Anesthesiologists ASA grade I,II and III, requiring general anaesthesia with orotracheal intubation in prone position during elective surgery were included and children with parents not giving consent,children with airway anomaly, laparoscopic surgery, and emergency surgery were excluded. Tracheal tube size was judged as adequate if the leak pressure was 20 cm H(2)O or less. Tube was exchanged to next larger size if the leak pressure was too high and tube size was exchanged to next smaller size, when cuff pressure exceeded 20 cm H(2)O. RESULTS: 60 infants were studied.In group 1 in which cuffed tube was used, there were no leaks,on the other hand, in group 2,17 out of 30 patients had peritubal leak and tube was exchanged to next larger size uncuffed tube, p value was <0.001. Moreover, the incidenceof accidental extubation, post extubation sore throat and stridor was more in uncuffed group, It was 2/6/6 in uncuffed group and 0/3/4 in cuffed group respectively. Tracheal tube exchange rate was also higher in uncuffed group. CONCLUSION: We found that in microcuff paediatric endotracheal tube, there is less peritubal leak; selection of cuffed tube with small internal diameter compared to uncuffed tubes implicates a higher chance for adequate fit of the tube at cricoid ring and due to this there is least chance of accidental extubation in the prone position.