The effect of the cytoreductive surgery and hyperthermic intraperitoneal chemotherapy procedure on endotracheal tube cuff pressure

Objective The cytoreductive surgery and hyperthermic intraperitoneal chemotherapy ( HIPEC) procedure is a relatively new modality in treatment that can benefit many abdominal cancer patients. This lengthy procedure has many steps with many anesthesia challenges. One of the challenges that we studied is the effect of this procedure on endotracheal tube (ETT) cuff pressure. Patients and methods After obtaining ethical approval, 25 patients of both sexes, ASA I and II, Mallampati I and II, who had undergone this surgery in our institute from 1 June 2013 to 1 October 2013 were enrolled in this study. In each patient, we measured the ETT cuff pressure five times, at the following time points: (a) immediately after intubation; (b) at the end of cytoreduction before the start of HIPEC; (c) at the end of HIPEC; (d) immediately before transfer to ICU; and (e) in the ICU immediately before extubation. Everytime, we reduced the cuff pressure (if higher) to 35 cmH2O using a Portex manometer. Statistical analyses were performed using SPSS version 17. Continuous variables were analyzed as mean ± SD or median (range) as appropriate. Rates and proportions were calculated for categorical data. Differences among the pressure of the ETT cuff over time were analyzed by analysis of variance test using the generalized linear model methodology, whereas a pairwise comparison was performed by the Bonferroni post-hoc test adjusted for multiplicity. P values less than or equal to 0.05 were considered significant. Results Pairwise comparisons between the ETT cuff pressure performed by the Bonferroni post-hoc test showed a significant difference between the ETT cuff pressure at all measured time points (P 0.005). Conclusion The cytoreductive surgery and HIPEC procedure has a significant effect on the ETT cuff pressure. We recommend close and frequent monitoring of the ETT cuff pressure during the steps of this major procedure.