A Study Of The Role Of Low-Injury Tracheal Tubes In Reducing Throat Complications After General Anaesthesia

PurposeWith the development of medicine,painless and comfortable medical treatment is more expected by patients,and 320 million patients undergo surgery every year,and general anesthesia has gradually become the preferred anesthesia method for surgery.Tracheal intubation has also become a clinical skill that every anesthesiologist must master and is an important means to ensure the safety of patients’lives.Tracheal intubation requires the use of endotracheal tubes,but the material,process,and design of the cuffs can affect patient comfort,leading professionals to invent new high-volume,low-pressure catheters.With the popularization of high-volume,low-pressure catheters and advances in materials science,serious complications after endotracheal intubation are rare,but endotracheal mucosal complications such as dysphagia,hoarseness,and sore throat due to improper cuff pressure setting are still common,so anesthesiologists’management of cuff pressure is crucial.The optimal cuff pressure required by the patient is a variable and is affected by many factors:including airway pressure,chest-lung compliance,position,etc.,the ideal cuff pressure is to ensure that the patient’s ventilation effect does not occur reflux aspiration leading to lung infection,and can minimize damage to the patient’s airway mucosa,while the patented low-damage tracheal tube can achieve a true idealization of endotracheal cuff pressure.To compare short-term throat complications after extubation in patients using a regular endotracheal tube versus a low-trauma endotracheal tube,the following studies were designed.MethodsThis clinical trial included 100 patients aged 18-80 years who had not undergone any endotracheal surgery,no throat discomfort,no lung infection,ASAI～II grade,no difficult airway,operation time of more than 3 hours,body mass index<28kg/m²,and planned to undergo elective general anesthesia for abdominal and lower extremity surgery requiring endotracheal intubation.Patients were randomized into general endotracheal catheter（N group）and low-damage endotracheal tube（L group）,with 50patients in each group.After anesthesia induction,the anesthesiologist with rich work was gently performed under visual laryngoscopy,and the intubation was successful.The cuff is inflated by anesthesiologist with experience.During the operation,the patient’s state of anesthesia required for surgery is maintained,and muscle relaxation is maintained.Noninvasive blood pressure,ECG,pulse oximetry,and end-respiratory carbon dioxide are continuously monitored intraoperatively.The observation indexes to evaluate the throat condition of patients after general anesthesia surgery were divided into main observation indicators:the pressure in the cuff was measured and recorded at the beginning of the operation and the end of the operation,and the state of the tracheal mucosa at the cuff at the moment of extubation.Secondary observation indexes:cough,sore throat,dysphagia and blood in sputum before leaving the room,throat pain in patients 24 hours after surgery,and lung infection 48 hours after surgery.Results1.There were no significant differences in height,weight,sex,endotracheal tube model,and time of endotracheal intubation between the two groups（P>0.05）.2.The pressure in the cuff was measured and recorded at the beginning of surgery and at the end of surgery,and the pressure in the endotracheal tube cuff（N group）was29.00±4.53 cm H₂O before the start of surgery and 28.30±4.60cm H₂O at the end of surgery.The pressure in the endotracheal tube cuff was 26.46±3.49cm H₂O measured before the start of surgery in the low-injury endotracheal tube group（L group）,and reached 25.96±3.33cm H₂O at the end of surgery.The comparison between the two groups showed that the pressure in the cuff in the ordinary endotracheal tube group（N group）was significantly higher at the beginning and end of surgery than in the low-injury endotracheal tube group（L group）（P₁=0.002,P₂=0.004,P<0.05）.3.Fiber bronchoscopic tracheal mucosal status score before extubation,compared between the two groups,there was a significant statistical difference between the tracheal mucosal injury in the ordinary endotracheal tube group（N group）and the low-damage endotracheal tube group（L group）（P=0.025,P<0.05）.4.Before the patient left the operating room after being fully awake,the incidence of throat discomfort symptoms in the ordinary endotracheal catheter group（N group）was cough（34%）,sore throat（46%）,dysphagia（12%）,blood in sputum（10%）,and the incidence of cough（14%）,sore throat（26%）,dysphagia（4%）,and blood in sputum（4%）in the ordinary endotracheal catheter group（N group）,respectively,among which the incidence of cough and throat pain increased significantly（P₁=0.017,P₂=0.03,P<0.05）.5.Postoperative sore throat score at 24h follow-up after surgery,compared with the two groups,there was no significant statistical difference between the postoperative sore throat score of patients in the ordinary endotracheal catheterization group（N group）and the low-trauma endotracheal catheter group（L group）（P>0.05）.6.Postoperative lung infection was followed up 48h after surgery,and there was no significant statistical difference between lung infection in the ordinary endotracheal catheter group（N group）and the low-trauma endotracheal catheter group（L group）（P>0.05）.Conclusion1.Low-damage tracheal catheter can reduce damage to the tracheal mucosa by reducing cuff pressure.2.Low-injury tracheal catheter can reduce the incidence of postoperative throat complications,such as:cough,sore throat.3.Low-damage endotracheal catheters do not cause reflux aspiration,increasing the chance of postoperative lung infection.