Background : Generally, an uncuffed endotracheal tube is used for general anesthesia in pediatric patients; thus, an inappropriate tube size intubation can lead to complications. In clinical practice, tube size selection can be done using a formula for estimating the size for each patient. An appropriate tube size should allow a leak at airway pressures (leak pressure) between 20-40 cmH2O, but leak pressure is not routinely monitored.
Objective : To study the incidence of inappropriate tube size used in pediatric patients receiving general anesthesia by using leak pressure test.
Design : Prospective, descriptive study.
Setting : Operating room, Srinagarind Hospital
Subject : Pediatric patients between 0 and 8 years of age undergoing general anesthesia with uncuffed endotracheal tube.
Methods : After anesthesia was induced and the patient was intubated, leaked pressure was measured. Leak pressure between 20 and 40 cmH2O was considered appropriate. We recorded each patients characteristics, number of attempts to intubate, leak pressure, duration of intubation, and respiratory complication. The result were analyzed using descriptive statistics and were presented as means, percentages and 95% confidence intervals (95%CI).
Results: We enrolled 98 patients averaging 2.3±2.2 years of age (67 males and 31 females). Patients with inappropriate leak pressure numbered 39 (39.80%), of which 24.49% (95%CI: 17,33) were in the group where leak pressure was ≥40 cmH2O and 15.31% (95%CI: 10,23) in the group where leaked pressure was <20 cmH2O. The most frequent complication was hoarseness 27.55% (95%CI: 20,37). No patients had any serious respiratory complications.
Conclusion : Pediatric patients between 0 and 8 years of age, undergoing general anesthesia with an uncuffed endotracheal tube had a 39.80% incidence of inappropriate endotracheal size used. Hoarseness was the most common complication (27.55%). Tube size selection should be done carefully and include leak pressure test.
Keywords : Uncuffed endotracheal tube; Leak pressure; General anesthesia; Pediatric patients