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. 2025 Jul;69(7):675-680.
doi: 10.4103/ija.ija_1046_24. Epub 2025 Jun 12.

Comparison between microcuff and wire-reinforced endotracheal tubes on postoperative complications in anterior cervical discectomy and fusion: A randomised study

S R Janani  1 , Dheeraj Masapu  2 , D N Dhananjay  3 , Satish Rudrappa  4 , Ramachandran Govindasamy  4 , T Jagadish  4
Affiliations

Comparison between microcuff and wire-reinforced endotracheal tubes on postoperative complications in anterior cervical discectomy and fusion: A randomised study

S R Janani et al. Indian J Anaesth. 2025 Jul.

Abstract

Background and aims: This randomised study investigated whether microcuff endotracheal tubes (ETT) reduce postoperative complications compared to wire-reinforced ETT in patients undergoing anterior cervical discectomy and fusion (ACDF).

Methods: In total, 120 patients were randomly assigned to receive either a microcuff ETT (Group M) or a wire-reinforced ETT (Group W) during surgery. Intraoperative cuff pressure changes due to retractor use were noted. Postoperative complications such as vocal cord palsy and airway oedema were observed at extubation, and hoarseness, sore throat, dysphagia, and stridor were assessed at 6, 24, and 48 hours after extubation. Data were analysed using SPSS v. 24 software. The sample size was calculated from a study based on the primary outcome, which is hoarseness of voice, to detect a 16% difference between the two groups, with 80% power and a significance level of P < 0.05.

Results: Both groups had similar baseline characteristics. The initial and post-retraction cuff inflation volumes were significantly lower in Group M. Cuff pressure increased significantly after retractor use in both groups (P < 0.001), with a greater increase observed in Group W. While no patient experienced stridor, vocal cord palsy, or airway oedema, the incidence of postoperative hoarseness was significantly lower in Group M (16.6% vs 6.7%) (P = 0.040). There were no significant differences in the rates of sore throat or dysphagia.

Conclusion: Microcuff ETT may offer advantages over wire-reinforced ETT during ACDF by potentially reducing the incidence of hoarseness, likely due to lower cuff pressure with preserved tracheal mucosal perfusion, and requiring less readjustment of the cuff after retractor application.

Keywords: Anterior cervical discectomy and fusion; cuff pressure; endotracheal tube; flexometallic; hoarseness of voice; microcuff; spine surgery; vocal cord palsy; wire-reinforced.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Digital cuff pressure manometer. The syringe is attached to the pilot balloon of the endotracheal tube. The volume of air injected can be measured with the markings on the syringe. The cuff pressure, which is transmitted to the pilot balloon, is measured by pressing the yellow button on the plunger. The pressure (in cm H2O) is displayed on the small screen on the plunger
Figure 2
Figure 2
Consolidated Standards of Reporting Trials (CONSORT) flow diagram
See this image and copyright information in PMC

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