Inhalationsanästhesie bei der Katze: Die Entwicklung des Cuffdrucks bei Verwendung von Lachgas

Zusammenfassung

Gegenstand und Ziel Die Verwendung eines Lachgas-/Sauerstoff-Gemischs bei einer Inhalationsanästhesie führt durch Diffusion von Lachgas in die Blockmanschette des Endotrachealtubus (Cuff) zu einem Anstieg des Drucks im Cuff, wenn dieser, wie üblich, mit Luft gefüllt wurde. Ziel der vorliegenden Studie war, die Entwicklung des Cuffdrucks während einer Isofluran-Lachgasanästhesie unter klinischen Bedingungen bei der Katze zu untersuchen und mögliche Einflussfaktoren wie Tubusgröße und Gesamtgasflussrate zu identifizieren.

Tiere, Material und Methoden In der prospektiven Studie wurden Katzen eingeschlossen, die in der Klinik für Kleintiere der Universität Leipzig eine Inhalationsanästhesie mit Lachgas über mindestens 60 Minuten erhielten. Der Cuffdruck wurde mit einem Cuffdruckmanometer auf den minimal-okklusiven Druck eingestellt und sein Verlauf aufgezeichnet.

Ergebnisse Insgesamt wurden Cuffdruckwerte von 24 Katzen aufgezeichnet, dabei wurde nach Tubusgröße (ID 4,0 mm und ID 4,5 mm) sowie nach Flussrate (niedrig 0,6 l/min und hoch 3 l/min) gruppiert. Es zeigte sich ein Anstieg des Cuffdrucks über die Zeit, ab dem Zeitpunkt 45 Minuten war dieser signifikant erhöht zum Ausgangswert (p=0,005). Nach 60 Minuten kam es zu einem mittleren Cuffdruckanstieg von 3 cmH₂O. Die Druckverläufe variierten individuell sehr stark, so wurden Werte bis zu 48 cmH₂O erreicht. Bei keiner Katze wurde das Abbruchkriterium von 60 cmH₂O Druck im Cuff erreicht. Effekte der Tubusgröße (p=0,63) und der Flussrate (p=0,334) auf den Verlauf des Cuffdrucks konnten nicht nachgewiesen werden.

Schlussfolgerung Nach 45 Minuten Lachgaszufuhr kommt es zu einem signifikanten Anstieg des Cuffdrucks bei der Katze. Die Tubusgröße und die Gesamtgasflussrate scheinen bei der Katze aber keinen Einfluss auf die Entwicklung des Cuffdrucks zu haben.

Klinische Relevanz Bei Nutzung von Lachgas im Rahmen einer Inhalationsanästhesie muss bei der Katze auf eine regelmäßige Kontrolle und Korrektur des Cuffdrucks geachtet werden. Die individuellen Druckverläufe sind allerdings so variabel, dass keine feste Empfehlung für ein optimales Management gegeben werden kann.

Abstract

Objective During inhalation anesthesia with nitrous oxide in oxygen the pressure in the cuff of the endotracheal tube may increase due to diffusion of nitrous oxide into the cuff. The aim of the study was to investigate the development of cuff pressure during nitrous oxide anesthesia under clinical conditions in feline patients and to identify possible influencing factors such as tube size and gas flow rate.

Material and methods The prospective study included cats scheduled for inhalation anesthesia with nitrous oxide for a minimum duration of 60 minutes at the Department for Small Animals of the University of Leipzig. Cuff pressure was adjusted with a cuff manometer and its development was recorded.

Results In total, the cuff pressure values of 24 cats were recorded. Animals were allocated into groups by tube size (ID 4.0 mm and ID 4.5 mm) and by fresh gas flow rate: low flow rate (0.6 l/min) and high flow rate (3 l/min). During anesthesia, cuff pressure increased over time, with statistical significance occurring from 45 minutes onwards in comparison to the initial cuff pressure (p=0.005). After 60 minutes, there was a mean cuff pressure increase of 3 cmH₂O. Despite this moderate mean increase, highly variable pressure values up to 48 cmH₂O in individual animals were recorded. No cat reached the termination criterion of 60 cmH₂O cuff pressure. Effects of tube size (p=0.63) and flow rate (p=0.334) on the cuff pressure were not evident.

Conclusion After a period of 45 minutes of nitrous oxide administration, a significant increase in cuff pressure occurs in the cat. However, tube size and total gas flow rate do not seem to influence the cuff pressure development.

Clinical relevance When using nitrous oxide during inhalation anesthesia, regular cuff pressure evaluation and correction are necessary and hence recommended in feline patients. As individual pressure changes may be highly variable, no fixed recommendations for optimal management are possible.

Schlüsselwörter

Endotrachealtubus - Cuffdruck-Manometer - Gasflussrate - High Volume-Low Pressure Cuff

Key words

Endotracheal tube - cuff manometer - flow rate - high volume-low pressure cuff

Publication History

Received: 15 April 2023

Accepted: 22 June 2023

Article published online:
13 November 2023

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