Cuffed endotracheal tubes in children reduce sevoflurane and medical gas consumption and related costs

Abstract

BACKGROUND: This study aims to evaluate sevoflurane and anaesthetic gas consumption using uncuffed vs. cuffed endotracheal tubes (ETT) in paediatric surgical patients.

METHODS: Uncuffed or cuffed ETT were used in paediatric patients (newborn to 5 years) undergoing elective surgery in a randomized order. Duration of assessment, lowest possible fresh gas flow (minimal allowed FGF: 0.5 l/min) and sevoflurane concentrations used were recorded. Consumption and costs for sevoflurane and medical gases were calculated.

RESULTS: Seventy children (35 uncuffed ETT/35 cuffed ETT), aged 1.73 (0.01-4.80) years, were enrolled. No significant differences in patient characteristics, study period and sevoflurane concentrations used were found between the two groups. Lowest possible FGF was significantly lower in the cuffed ETT group [1.0 (0.5-1.0) l/min] than in the uncuffed ETT group [2.0 (0.5-4.3) l/min], P<0.001. Sevoflurane consumption per patient was 16.1 (6.4-82.8) ml in the uncuffed ETT group and 6.2 (1.1-14.9) ml in the cuffed ETT group, P=0.003. Medical gas consumption was 129 (53-552) l in the uncuffed ETT group vs. 46 (9-149) l in the cuffed ETT group, P<0.001. The total costs for sevoflurane and medical gases were 13.4 (6.0-67.3)euro/patient in the uncuffed ETT group and 5.2 (1.0-12.5)euro/patient in the cuffed ETT group, P<0.001.

CONCLUSIONS: The use of cuffed ETT in children significantly reduced the costs of sevoflurane and medical gas consumption during anaesthesia. Increased costs for cuffed compared with uncuffed ETT were completely compensated by a reduction in sevoflurane and medical gas consumption.