6 - Deflating the endotracheal tube pilot cuff

Summary

Key learning points

• Understanding the literature behind safe deflation of the ET tube cuff

• Implications of non-deflated pilot tubes

• Review of manufacturers' ET guidelines

Introduction

Tracheal extubation of patients following anaesthesia is a complex and skilled procedure that carries potential risks of various complications. These risks range from minor, such as a sore throat, to major life-threatening complications, such as airway obstruction. Minimisation of these risks is essential if recovery from anaesthesia is to be smooth and trouble free. There are many different methods employed by anaesthetists and perioperative staff for the extubation of post-operative patients within theatre or in the recovery room. The deflation of the endotracheal tube cuff with a syringe is generally advocated, but there are times when the cuff is deflated by snapping or cutting off the pilot tube apparatus. This practice infringes all guidelines and advice given in textbooks, journals and by endotracheal tube manufacturers. There is evidence that this practice could lead to, or aggravate, some potentially harmful post-anaesthetic complications.

Defining the problem

Asai et al. (1998) studied respiratory problems associated with both intubation and extubation and found the incidence of complications associated with extubation were significantly higher than during the induction of anaesthesia (p < 0.001). They therefore implied that ‘the incidence of respiratory complications associated with tracheal extubation may be higher than that during tracheal intubation’ (Asai et al., 1998).