Can removal of cuff of cuffed endotracheal tube be a suitable substitute for uncuffed endotracheal tube in children?

• DOI: 10.4103/jigims.jigims_24_23
• Publication Date: 2023-10-27T10:56:37Z
• Authors: Amrita Rath; Reena; Ghanshyam Yadav
• Keywords: Cuff; Tracheal tube; Subglottic stenosis; Endotracheal tube

Sir, Endotracheal intubation is a routine procedure while administering general anesthesia for surgeries in children. The use of uncuffed or cuffed tracheal tubes (TT) children has its advantages and disadvantages. Cuffed TTs under were not preferred long, as they could cause airway mucosal injury, which eventually may lead to subglottic stenosis.[1] It pertinent here note that although tube can easily pass the vocal cords, it get stuck at level. Thus, properly sized TT very important However, sometimes, appropriate sizes are available. We describing case we removed cuff used an desired size pediatric patient, with additional advantage pilot channel being suction port. A 10-year-old boy, weighing 21 kg, was posted modified radical mastoidectomy. plan per our institutional protocol. standard protocol induction. Gentle direct laryngoscopy then done, number 6 inserted after visualization cord. passed cords; however, resistance felt region; hence, removed, smaller tube; initially, 5.5 5 tried; similar problem encountered. Finally, 4.5 through high diameter small. Due nonavailability 5/5.5 operation theater, decided manually strip off without disturbing balloon, patient smoothly intubated same [Figure 1]. intraoperative period uneventful. extubated end surgery, there no postoperative sore throat hoarseness on follow-up.Figure 1: Tracheal removing (the arrow pointing open catheter patency been shown by injecting dye balloon. be port aspirate infraglottic secretions)Earlier advocated because seals circular cricoid ring, preventing major aspiration, allows adequate ventilation, but leaks about 20–25 cm water pressure. presence air leak ensures pressing mucosa against cartilage result ischemia sequelae. recent studies have suggested shape lumen elliptical rather than (with transverse less anteroposterior diameter).[2] placement elliptical-shaped application undue pressure posterolateral position, occurring inspiratory H2O arise only from anterior part lumen. Normal routinely patients would lie between cords even space if placed according age-related formulae predicting depth insertion. They also carry risk endobronchial kept below glottis. requires mandatory monitoring frequently avoid pressure-induced ischemia.[3] Microcuff are, therefore, suitable associated these complications.[4] due unavailability microcuff TT, usual case, encountering difficulty negotiation subglottis, stripped Using this avoided disadvantage cuff-induced injuries obviated need pressures aneroid manometer. Deflating completely resulted folds wrinkles sharp edges, lacerate delicate laryngeal passage subsequent movement during ventilation. left functional clearing out secretion aspirating syringe. possible suggesting maneuver; special situations where either available cannot negotiated glottis, uncuffing save lot time effort providing oxygenation Declaration consent authors certify obtained all forms. In form, patient(s) has/have given his/her/their images other clinical information reported journal. understand their names initials will published efforts made conceal identity, anonymity guaranteed. Financial support sponsorship Nil. Conflicts interest There conflicts interest.