Effect of cuff inflation with lidocaine, saline, and air on tracheal tube cuff pressure during laparoscopic resection of colorectal neoplasms: a randomized clinical trial.

BACKGROUND: Tracheal tube cuff pressure will increase after pneumoperitoneum when the cuff is inflated with air, high pressure can cause tracheal mucosal damage. This prospective trial aimed to assess if inflating with normal saline or lidocaine can prevent increase of tracheal tube cuff pressure and tracheal mucosal damage in laparoscopic surgeries with general anesthesia. Whether changes of tracheal tube cuff transverse diameter (CD) can predict changes of tracheal tube cuff pressure. METHODS: Ninety patients scheduled for laparoscopic resection of colorectal neoplasms under general anesthesia were randomly assigned to groups air (A), saline (S) or lidocaine (L). Endotracheal tube cuff was inflated with room-temperature air in group A (n = 30), normal saline in group S (n = 30), 2% lidocaine hydrochloride injection in group L (n = 30). After intubation, tracheal tube cuff pressure was monitored by a calibrated pressure transducers, cuff pressure was adjusted to 25 cmH2O (T0.5). Tracheal tube cuff pressure at 15 min after pneumoperitoneum (T1) and 15 min after exsufflation (T2) were accessed. CD were measured by ultrasound at T0.5 and T1, the ability of ΔCD (T1-0.5) to predict cuff pressure was accessed. Tracheal mucous injury at the end of surgery were also recorded. RESULTS: Tracheal tube cuff pressure had no significant difference among the three groups at T1 and T2. ΔCD had prediction value (AUC: 0.92 [95% CI: 0.81-1.02]; sensitivity: 0.99; specificity: 0.82) for cuff pressure. Tracheal mucous injury at the end of surgery were 0 (0, 1.0) in group A, 0 (0, 1.0) in group S, 0 (0, 0) in group L (p = 0.02, group L was lower than group A and S, p = 0.03 and p = 0.04). CONCLUSIONS: Compared to inflation with air, normal saline and 2% lidocaine cannot ameliorate the increase of tracheal tube cuff pressure during the pneumoperitoneum period under general anesthesia, but lidocaine can decrease postoperative tracheal mucosa injury. ΔCD measured by ultrasound is a predictor for changes of tracheal tube cuff pressure. TRIAL REGISTRATION: Chinese Clinical Trial Registry, identifier: ChiCTR2100054089, Date: 08/12/2021.

Effect of tracheal tube cuff inflation with alkalinized lidocaine versus air on hemodynamic responses during extubation and post-operative airway morbidities in children: prospective observational cohort study, Ethiopia.

BACKGROUND: Endotracheal tube with an inflated cuff was used to manage and maintain the airway during general anesthesia in children. When the lateral pressure exerted by an inflated Endotracheal tube cuff on tracheal mucosa exceeds capillary perfusion pressure, patients may complain of cough, sore throat, and hoarseness in the postoperative period. This study aimed to assess the effect of a tracheal tube cuff filled with alkalinized lidocaine versus air on hemodynamic parameter changes during extubation and post-operative airway morbidity in children. METHODS: Institutional based observational prospective cohort study was conducted among 56 elective children; aged 3-13 years, who underwent operation under general anesthesia with cuffed endotracheal intubation for greater than one hour by grouping into the air (group1) and alkalinized Lidocaine (group2) at Tikur Anbessa specialized Hospital. Hemodynamic parameters (Heart rate and Blood pressure) and other variables were measured starting from 5 min before extubation to 24th hours after extubation of the endotracheal tube. A Comparison of numerical variables between study group was done with an independent t-test. Data were expressed in terms of mean ± standard deviation. Categorical data were assessed by Chi-square tests. RESULTS: Postoperative Sore throat was lower in alkalinized lidocaine group compared to the air group. The mean heart rate at five minutes after extubation was significantly lower in alkalinized lidocaine group (107.29 ± 6.457 beat per minute (bpm)) compared to the air group (122.04 ± 8.809 bpm), with P ≤ 0.001. Systolic blood pressure was also significantly lower in alkalinized lidocaine group (99.64 ± 8.434 millimeters of mercury (mmHg)) compared to the air group (108.21 ± 11.902 mmHg), p = 0.016 at five minutes after extubation. CONCLUSION: Alkalinized lidocaine inflated tracheal tubes have shown improved hemodynamic and laryngotracheal morbidities in children.

Th-1 cytotoxic cell-mediated response predominates in the tracheal mucosa following Mycoplasma synoviae infection of MS-H-vaccinated chickens.

Mycoplasma synoviae is a pathogen of poultry that causes upper respiratory tract disease. MS-H is a live attenuated temperature-sensitive vaccine that effectively control M. synoviae infection in chickens. However, the mechanisms underpinning protection have not been described previously. In this study, specific-pathogen-free chickens were vaccinated at 3 weeks of age with MS-H vaccine and challenged with field strain M. synoviae 94011/v-18d at 6 weeks of age. Tracheal mucosal inflammation was characterised by the assessment of thickness, histopathological lesions, cellular infiltrates and cytokine transcription. Tracheal lesion scores of unvaccinated-challenged (-V+C) birds were higher than that of vaccinated-challenged (+V+C) birds. +V+C birds displayed early upregulation of IL-4, consistent with a Th-2-skewed response, followed by a later increase in IFN-γ transcription, indicating transition to a Th-1-skewed response. -V+C birds displayed a concurrent early Th-2 and Th-17 response characterised by increase expression of IL-4 and IL-17A respectively, and late T regulatory response characterised by increased IL-10 transcription. +V+C chickens had more cytotoxic T cells (CD8+ T cells) at 7- and 21 days post-challenge (dpc), while -V+C chickens had higher numbers of infiltrating CD4+CD25+ at 7 and 21 dpc. Overall, these observations suggest that the immune response in +V+C chickens had an inflammation characterised by an early Th-2 skewed response followed closely by a Th-1 response and infiltration of cytotoxic T cells, while the response in -V+C chickens was an early Th-2/Th-17-skewed response closely followed by a T regulatory response.

Resection of tracheal mucosa-associated lymphoid tissue (MALT) lymphoma by bronchoscopic high-frequency electrosurgical snare: Case report.

There is no standard method of bronchoscopic local therapy for tracheal tumours. We herein present a case involving a 61-year-old woman who was diagnosed with tracheal mucosa-associated lymphoid tissue lymphoma and underwent resection by a bronchoscopic high-frequency electrosurgical snare. Few reports to date have described such use of high-frequency electrosurgical snares; however, they are effective for the treatment of tracheal tumours, especially pedunculated tumours.

Evaluation of audible leak versus pressure volume loop closure for polyvinyl chloride cuff and polyurethane microcuff in endotracheal tube inflated with air: a prospective randomized study.

Cuff pressure of endotracheal tube (ETT) must be high enough to seal the trachea, and must be low enough to allow adequate perfusion of tracheal mucosa. Compared with polyvinyl chloride (PVC) cuffed tubes, polyurethane cuffed tubes protect more efficiently. Different methods of ETT cuff pressure maintenance in practice have been reported. We planned to compare ETT cuff pressure using different techniques in PVC and polyurethane microcuff tubes in a prospective randomized study. Eighty surgical patients between 16-65 years belonging to American Society of Anesthesiologists physical status I-III, scheduled for orotracheal intubation under general anaesthesia, were included. All enrolled patients were randomized into four groups (n = 20 per group), followed by corresponding treatments, including intubation by PVC ETT or polyurethane microcuff ETT and cuff inflation by auscultation of audible leak or pressure volume loop. Amount of air required to inflate cuff was more in polyurethrane tube as compared to polyvinyl tube. While comparing the two methods of cuff inflation, less volume of air was required in pressure volume loop method. We concluded that PVC cuff tube and polyurethane microcuff tube both are safe tubes used in adult patients. However, when inflated using same technique polyurethane microcuff tubes required larger volume to inflate cuff. Further, pressure generated in polyurethane microcuff tubes in much lower than PVC tubes. The study was approved by the Institutional Ethics Committee of Pt B D Sharma, PGIMS, Rohtak (No. IEC/Th/18/Anst15) on January 20, 2018 and registered with Clinical Trials Registry-India (registration No. CTRI/2019/01/017170) on January 18, 2019.

A rational tissue engineering strategy based on three-dimensional (3D) printing for extensive circumferential tracheal reconstruction.

Extensive circumferential tracheal defects remain a major challenging problem in the field of tracheal reconstruction. In this study, a tissue-engineered tracheal graft based on three-dimensional (3D) printing was developed for extensive circumferential tracheal reconstruction. A native trachea-mimetic bellows scaffold, a framework for a tissue-engineered tracheal graft, was indirectly 3D printed and reinforced with ring-shaped bands made from medical grade silicone rubber. A tissue-engineered tracheal graft was then created by stratifying tracheal mucosa decellularized extracellular matrix (tmdECM) hydrogel on the luminal surface of the scaffold and transferring human inferior turbinate mesenchymal stromal cell (hTMSC) sheets onto the tmdECM hydrogel layer. The tissue-engineered tracheal graft with critical length was anastomosed end-to-end to the native trachea and complete re-epithelialization was achieved on the entire luminal surface within 2 months in a rabbit model with no post-operative complications. With this successful result, the present study reports the preliminary potential of the tissue-engineered tracheal graft as a rational tissue engineering strategy for extensive circumferential tracheal reconstruction.

Expression of pIgR in the tracheal mucosa of SHIV/SIV-infected rhesus macaques.

Polymeric immunoglobulin receptors(pIgR) are key participants in the formation and secretion of secretory IgA(S-IgA), which is critical for the prevention of microbial infection and colonization in the respiratory system. Although increased respiratory colonization and infections are common in HIV/AIDS, little is known about the expression of pIgR in the airway mucosa of these patients. To address this, the expression levels of pIgR in the tracheal mucosa and lungs of SHIV/SIV-infected rhesus macaques were examined by real-time RTPCR and confocal microscopy. We found that the levels of both PIGR mRNA and pIgR immunoreactivity were lower in the tracheal mucosa of SHIV/SIV-infected rhesus macaques than that in non-infected rhesus macaques, and the difference in pIgR immunoreactivity was statistically significant. IL-17A, which enhances pIgR expression, was also changed in the same direction as that of pIgR. In contrast to changes in the tracheal mucosa, pIgR and IL-17A levels were higher in the lungs of infected rhesus macaques. These results indicated abnormal pIgR expression in SHIV/SIV, and by extension HIV infections, which might partially result from IL-17A alterations and might contribute to the increased microbial colonization and infection related to pulmonary complications in HIV/AIDS.

Histopathologic Changes of Rat Tracheal Mucosa Following Formaldehyde Exposure / Cambios Histopatológicos de la Mucosa Traqueal de la Rata Seguidos a la Exposición de Formaldehído

Formaldehyde is a chemical, which is used traditionally for fixing the cadaver. It is vaporized during dissection and practical studying on cadaver. Studies show that this vapor can cause some clinical symptoms such as throat, eye, skin and nasal irritation. This study was designed to determine the histopathologic changes of rat tracheal mucosa while all of the experiments were exposed to formaldehyde for 18 weeks. This study was performed on 28, 6-7 weeks postnatal albino Wistar rats. The rats were divided into 3 case groups (E1: 4h/d, 4d/w; E2: 2h/d, 4d/w; E3: 2h/d, 2d/w) and 1 control group. The tracheal specimens were sectioned and stained with H&E technique for histopathologic study. An epithelial disorganization, cilia disappearance, slight dysplastic changes and slight subepithelial lymphocytic infiltration were observed in the case of E1. Epithelial disorganization, irregular cilia and slight subepithelial infiltration were seen in E2 and E3 groups. The results of this study show that "the more exposure to formaldehyde vapor, the more intense epithelial changes".

El formaldehido es un producto químico que se usa tradicionalmente para la fijación de cadáveres. Éste se vaporiza durante la disección y los estudios prácticos en el cadáver. Investigaciones han mostrado que este vapor puede causar algunos síntomas clínicos como la irritación de garganta, ojos, piel y mucosa nasal. Este estudio tuvo como objetivo determinar los cambios histopatológicos en la mucosa de la tráquea de la rata para lo cual todos los animales fueron expuestos al formaldehído, durante 18 semanas. El estudio fue realizado en 28 ratas albinas Wistar, con 6-7 semanas de vida. Las ratas fueron divididas en 3 grupos (E1: 4h/día, 4días/semana; E2: 2h/día, 4días/semana; E3: 2h/día, 2días/semana) y un grupo control. Fueron seccionadasas las tráqueas de los especímenes y teñidas con H&E para su estudio histopatológico. Una desorganización epitelial, desaparición de cilios, leves cambios dispásticos y leve infiltración linfocítica subepiteial fueron observados en el grupo E1. Desorganización epitelial, cilios irregulares y leve infiltración subepitelial fueron observados en los grupos E2 y E3. Los resultados de este estudio muestran que a mayor exposición al vapor del formaldehido, más intensos son los cambios epiteliales de la mucosa traqueal.

Histopathologic Study on the Effect of Tracheal Mucosa after Inhalation of O-Chlorobenzylidene Malononitrile(CS) in the Rats / 대한이비인후과학회지

This study was undertaken to investigate the histopathological change in the tracheal mucosa of rats by light microscope following acute exposure to ortho-chlorobenzylidene malononitrile(CS). 2.0g/m3 of CS was inhalated to experimental rats for 20 minutes per day during 3 days in a plastic chamber. The experimental animals were sacrificed at 12 hours, 24 hours, 3 days, and 5 days after CS gas exposure. Specimens were obtained from upper most part of tracheal mucosa of the rats. After H and E stain and PAS stain were performed, all specimens were observed by light microscope. The result were as follows: 1) At 12 hours after exposure , there were some cilia destruction, widening of lamina propria, and infiltration of inflammatory cells in subepithelial layer. Epithelial lining and goblet cells were well preserved. 2) At 24 hours after exposure, epithelial lining and basement membrane were destructed and goblet cells were decreased in number. Infiltration of inflammatory cells in subepithelial layer were as sustained and vascular congestion was observed. 3) At 3 days after exposure, regeneration of epithelial layer, goblet cells, and basement membrane were identified. In subepithelial layer, a few inflammatory cells were infiltrated. 4) At 5 days after exposure, intact epithelial layer and numerous normal goblet cells were appeared. Lamina propria was narrowed and no inflammatory cells were in subepithelial layer. The results suggested that the tracheal mucosa of the rats shows a siginificant degenerative change after acute exposure to ortho-chlorobenzylidene malononitirile. However, it was temporary and reversible change.