Deflated and Inflated Cuff Endotracheal Extubations

Launched by NAVAL MEDICAL CENTER CAMP LEJEUNE · May 17, 2025

Keywords

ClinConnect Summary

The current standard anesthetic practice for extubation is to deflate the endotracheal tube cuff using a syringe prior to extubation. While commonplace and nearly universally accepted, this practice is not based on evidence from randomized controlled trials but is instead due to concern for laryngeal or vocal cord injury and arytenoid cartilage dislocation. However, no publications exist in the medical literature that attribute laryngeal trauma directly to inflated cuff endotracheal tube extubation, as opposed to the process of extubation in general. To the contrary, case reports that descr...

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Eligibility criteria

• Inclusion Criteria:
• • Adults aged 18 to 50 years old
• • Scheduled for surgery, not of the airway, head, or neck, with anticipated case duration of less than 3 hours
• • American Society of Anesthesiologists (ASA) Physical Status Classification of 1 to 3
• Exclusion Criteria:
• • Emergent surgery, or surgery requiring prone, sitting or lateral positioning
• • Pre-existing laryngeal pathology, obstructive pulmonary disease, pulmonary hypertension, interstitial lung disease, active respiratory infection, recent pneumonia, uncontrolled asthma, or uncontrolled gastroesophageal reflux disease
• • Known difficulties with general anesthesia, such as prior anaphylactic reaction, difficult intubation or mask ventilation
• • Known allergy to iohexol or a previous severe reaction to any contrast agents
• • Unfavorable airway examination, such as Mallampati 4, limited mouth opening, and/or inability to extend neck
• • Non-compliance with ASA Practice Guidelines for Preoperative Fasting
• • Pregnancy
• • Enrollment in another anesthesiology or surgery related interventional research study
• • Surgeries scheduled on Friday or a day immediately prior to a holiday