DIFFUSION OF NITROUS OXIDE INTO TRACHEAL TUBE CUFF DURING GENERAL ANESTHESIA

Dušikov oksidul med daljšimi splošnimi anestezijami difundira v tesnilni mešiček sapničnega tubusa (dihalne cevke), ga razširi in posledično poveča tlak v mešičku. To povzroča ishemične poškodbe na sluznici sapnika, kar se izraža z bolečim grlom ali hripavostjo po operaciji s splošno anestezijo. Namen raziskave je bil ugotoviti in raziskati vpliv difuzije dušikovega oksidula v tesnilni mešiček. Raziskovalna metodologija: raziskava je temeljila na kvantitativni eksperimentalni metodologiji, ki je potekala v Splošni bolnišnici Ptuj. V raziskavo je bilo vključenih 45 bolnikov, operiranih v abdomnu. Z manometrom smo spremljali spremembe tlaka v mešičku in jih merili ob intubaciji (vstavitev dihalne cevke), ter v intervalih po 10 minut do konca anestezije. V drugem delu raziskave smo s kratko telefonsko anketo preverili, kakšna je praksa po drugih bolnišnicah v Sloveniji glede na nadzor nad tlakom v mešičku. Rezultati: Naraščanje tlaka v tesnilnem mešičku tubusa se začne po 15 minutah uporabe dušikovega oksidula. Večje naraščanje tlaka je bolj opazno pri višjih koncentracijah dušikovega oksidula (55 % in 60 %), ko lahko tlak naraste dva- do trikrat po 50 minutah uporabe dušikovega oksidula. Ugotovili smo, da obstaja statistična razlika med časom in tlaki v mešičku sapničnega tubusa med splošno anestezijo ob uporabi 60 % dušikovega oksidula (p < 0,05). Sklep: Uvedba nadziranja in merjenja tlaka v mešičkih sapničnih tubusov med splošno anestezijo z dušikovim oksidulom bi morala postati ustaljena praksa – standard v zdravstveni negi, saj bi tako bolniku po ekstubaciji v pooperativnem obdobju preprečili bolečine in neprijetne občutke v grlu.During longer general anesthesia nitrous oxide diffuses into the seal cuff of the endotracheal tube (breathing tube), widens it and consequently increases the pressure in the cuff. This causes ischemic injuries to the tracheal mucosa, which results in a sore throat or hoarseness following surgery under general anesthesia. The aim of the research was to determine and study the influence of nitrous oxide diffusion into the seal cuff. Research method: The research was based on a quantitative experimental methodology, carried out at the General hospital in Ptuj. 45 abdominal surgery patients were included in the research. We monitored the pressure changes within the cuff with a manometer and measured it at the intubation (insertion of the breathing tube) and then in 10 minute intervals throughout the entire anesthesia process. For the second part of the research we conducted a short telephone poll to inquire about the cuff pressure monitoring practices in other hospitals across Slovenia. Results: The pressure in the seal cuff of the tube starts increasing after 15 minutes of administering nitrous oxide. The pressure increase is more prominent with higher nitrous oxide concentrations (55% and 60%), where the pressure can increase by a factor of 2 to 3 after 50 minutes of administering nitrous oxide. We identified a static difference between the time and pressure within the seal cuffs of the endotracheal tube during general anesthesia with the use 60% nitrous oxide (p