Need for New Standards

Prevention of Subglottic Stenosis

As anesthesia providers, we have the privilege of providing care to patients during surgery, and with that privilege comes responsibility for their welfare. Because of this privilege and responsibility we would like to bring attention to routine adult endotracheal tube (ETT) practices in the OR that may place patients at unnecessary risk. These practices are:

#1: The blind inflation of pilot balloons, and

#2: The use of large-sized endotracheal tubes, especially for women.

High cuff pressure and large ETTs have both been implicated as causative factors of complications. From post-operative sore throat and hoarseness to catastrophic tracheal stenosis and recurrent laryngeal nerve (RLN) paralysis, these complications can have long-term negative sequel for our patients. As anesthesia providers, it is our duty to honor the Hippocratic oath of "first, do no harm" and adopt better practices.

New standards that need to be instituted include:

#1: Cuff pressure will be checked with each and every intubation, and

#2: Standardized tube sizes of endotracheal tubes in adults need to be decreased. Specifically, downsize to 6.0 ETT for most females and no larger than 7.5 for men.

Routine care will be described, followed by the supporting research for the proposed new standards. The articles and books cited should not be considered exhaustive of the research that supports these standards. It should also be known that there is no evidence found to support routine care as it is delivered today. Only the first author’s last name will be given followed by a full bibliography at the end.

<Arguments Against the Arguments in Support of Routine Care>

<References>