Intraoperative Measurement of Endotracheal Tube Cuff Pressure and Its Change During Surgery in Correlation With Recurrent Laryngeal Nerve Palsies, Hoarseness, and Dysphagia After Anterior Cervical Discectomy and Fusion: A Prospective Randomized Controlled Trial

Alena Sejkorová; Martin Bolcha; Jan Beneš; Jiří Kalhous; Martin Sameš; Petr Vachata

doi:10.1177/21925682211046895

Intraoperative Measurement of Endotracheal Tube Cuff Pressure and Its Change During Surgery in Correlation With Recurrent Laryngeal Nerve Palsies, Hoarseness, and Dysphagia After Anterior Cervical Discectomy and Fusion: A Prospective Randomized Controlled Trial

Global Spine J. 2023 Jul;13(6):1635-1640. doi: 10.1177/21925682211046895. Epub 2021 Sep 29.

Authors

Alena Sejkorová^{1

2}, Martin Bolcha^{1

3}, Jan Beneš^{4

5}, Jiří Kalhous^{5

6}, Martin Sameš¹, Petr Vachata^{1

3}

Affiliations

¹ Department of Neurosurgery, Masaryk Hospital, J. E. Purkyně University, Ústí nad Labem, Czech Republic.
² Second Faculty of Medicine in Prague, Charles University in Prague, Prague, Czech Republic.
³ The Faculty of Medicine in Pilsen, Department of Neurosurgery, University Hospital in Pilsen, Charles University in Prague, Prague, Czech Republic.
⁴ Department of Anesthesiology, Perioperative Medicine and Intensive Care, Masaryk Hospital, J J. E. Purkyně University, Ústí nad Labem, Czech Republic.
⁵ Faculty of Medicine in Hradec Kralove, University Hospital, Charles University in Prague, Hradec Kralove, Czeck Republic.
⁶ Department of Otorhinolaryngology, Head and Neck Surgery Department, Masaryk Hospital, J. E. Purkyně University, Ústí nad Labem, Czech Republic.

Abstract

Study design: Prospective randomized controlled trial.

Objectives: Adjustment of endotracheal tube cuff pressure (ETCP) in anterior cervical discectomy and fusion (ACDF) may influence the incidence of complications such as recurrent laryngeal nerve palsy (RLNP), hoarseness, and dysphagia.

Methods: The prospective randomized controlled trial was designed to investigate the influence of ETCP on the incidence of postoperative complications. All eligible patients underwent vocal cord examination before and after ACDF and were randomized into a control group (CG) and intervention group (IG). Endotracheal tube cuff pressure was passively monitored in CG, and in IG, it was maintained at 20 mmHg. Outcomes were evaluated during hospitalization and during follow-up.

Results: A total of 98 patients were randomized, each group consisted of 49 patients. Statistical analysis showed that gender and age did not influence the incidence of complications. In CG, duration of retractor placement and extent of approach significantly impacted the occurrence of complications. The incidence of postoperative RLNP was 8.2% in IG and 12.2% in CG, hoarseness and dysphonia were present in 18.4% in IG and in 37.5% in CG, and dysphagia in 20.8% in IG and in 22.5% in CG. Hoarseness was significantly present more in CG (P = .018). Only one patient from CG presented with RLNP after 1 year, the remaining nine patients spontaneously recovered.

Conclusions: Unregulated ETCP can lead to a significantly higher incidence of hoarseness; however, its improvement rate is 100%. The early postoperative complication rate was higher in CG, and after one year, 1 patient had RLNP and 1 patient had dysphagia.

Keywords: anterior cervical discectomy and fusion; dysphagia; endotracheal cuff pressure; hoarseness; prospective randomized controlled trial; recurrent laryngeal nerve palsy; risk factors.