430
CIJNICAL REPOKI'S
of the effects of cyanide toxicity may be achieved by limiting the hourly or total close of SN1',0*i2by administration of tliiosulf~ite,':'.'"h yclroxocobalamin'" or cystine,"' although aclclitional studies are neeclecl to evaluate these methocls.
RI.:I:ERENCES
.
1 L;iriirits-Biirlciw P, Noriiiiil Gbl: Fiitiil ciiscs of' poisoning witli sotliuni iiitropriissitlc. Br hlctl J 2:407, 1!)4 I 2. .Jiick RD: 'I'osicity of' sotliuni ~iitrnl~r~tssitlc. Br J Anacstli 46: !)52, 1974
3. Mcrrificltl AJ, Bliiiitlcll hl D: 'I'osicity ol'soclium nitroprtissitlc, Br J Aiiiicstli 46:324. 1974 4, D:ivics D\\',Kiicliir D, Stcwiutl DJ, ct ;iI: A sutltlen clciith nssocintccl with tlic iisc of' soclium iiitroprussiclc for intluctioii of Iiy~~otciisioii diiring iiiincstlicsia. Can Annesth Soc 22:547-
552, 1975
\VR,01vcii M: Scvcrc nictiiliolic acidosis fnllowing hypotcnsioii inducctl with soclium nitroprussitlc. Br J
5 . bliicfiic
A ~ i i i c ~ t463795-797, li 1974 6. Dnvics D\\', Grciss L, Kiicliir D,ct id: Socliuni nitroprussiclc in cliiltlreii: Ol~ser\~iitions on iiicti~bolisnitluring norinid sntl itbi~t~r~iiid ICS\)OIISCS. Ciiii Aliiicsth SOC J 22:553-560, 1975 7. Cohcn S L I-Iypcrteiisioiiin rciiiil tr;insplant rccipicnis. Role of 1)iliitcriil ncplircctot~iy.Br hlctl J 3:78-81, 1973
8. l'ii~)iitlitiiitri~)\~ N, Cliisolin CD,Sliiicliinn~iR: I-Iypcrtcnsion in piticiits 011 rcgltliir hcniotliiilysis i1lid iif'tcr ~ e i i i iilloiraiis~l plaiiiation. Liincci 1302-906, 1969
9. Kiincko Y, Ikctlii -I., Tiikcda T': Rcnin rclcnsc during ncutc rctluctioii 0 1 iirtcrinl prcssiirc in norniotcnsivc siib&is and piiticnts with rciioviisciiliw hylicrtciision. J C h i lnvcst 46: 705-7 16, 1967 10. Piilnicr RF, Liissctcr KD:Sotliiun tiitropriissitlc. N Engl J Met1 292:294-297, 1975 11. McDowall DC. Kcniicy Nl', Turner J M , ct nl: The toxicity of sodium niiroprussitlc. Br J Anacstli 46:327-332, 1974 12. 'I'inkcr JI-I, Michciif'cltlcr JD: Socliuni tiitropriissitlc: Phnrniacology, ~oxicologynncl tlierapcutics. ANESTIIESIOLOGY 45: 340-354, 1976 13. Siiiitli RP: Cynnatc nntl tliiocyinatc: Aciitc toxicity. Proc Soc Exp Biol blctl 142:1041-1044, 1973 14. Smith RP, Kriiszynii I-I: Nitroprusside produces cynnidc poisoning viii ii rcsction with hcnioglobin. J Pliarnincol Exp Tlicr 191:557-5(i3, 1974 15. Luticr F, Diisolcil,'l rlch4ontgrosJ: Action clc I'hydroxocobnlaniitic ii tlosc niiissivc t h i s I'intoxicntion niguc nu cyiriiirc (;I tropos tl'un ciis). Arch tlcs Mnhtlics Profcssionclles dc blctlcciiic tlc Triiviiil ct clc Sccuritc Socinle 32683-688,
1971 16. \Vootl JL, Coolcy S L I~cioxicniioiiof cyiiiiitlc by cystinc. J Biol Clicni 2 I X:449-457, 1!)56
Ancsilicsiology
4 !):4:50-'1 32, I !I78
Postoperative Sore Throat -Importance of Endotracheal Tube Conformity Versus Cuff Design EDWARD A. LOESER,M.D.,*' RICHARD MACIIIN, D.D.S.,t JOEL COLLEY,M.D.,? DANIELORR, 11, D.D.S.,? GEORGEM. BEN NET'^, M.D.,$ TI-IEODORE H. STANLEY, M.D.# Recent investigations have suggested that both conformity of an endotracheal tube to the anatomic contour of the pharynx' ancl the design of the cuff2 may have profound effects on the incidence and magnitude of postoperative sore throat. In this study, endotracheal tube anatomic conformity was evaluated ancl comparecl with cuff design as a factor in the occurrence of postoperative sore throat.
M K ~ I - 1DS 0 Postoperative sore throat was evaluated i n 250 patients who had undergone abdominal or extremity operations. Patients had their tracheas intubated with 7.0-8.5-mm I D National Catheter Company
* Instructor i n Anesthesiology. Resiclent in Ancstlicsiology. $ Assistiitit l'rol'cssor of Ancstlicsiology. $ Associiitc Prof'cssor of' Aiicstliesiology/Siirgcry. Rcceivctl f'roiii thc Dcp;irtiiicnt of' Aiicstlicsiology,thc University of UIiIli Collcgc of' Mccliciiie, 50 North b1cdic;il Drive, Salt Lakc City, Utah 8~1132.Acccptctl for publication hliirch 10, 1978. Aclclrcss rcpriiit requests to Dr. Locser.
"Lindholm" pharyngeal molded endotracheal tubes with high-residual-volume, high-tracheal-contact, low-pressure cuffs or low-residual-volume,low-trachealcontact, higher-pressure cuffs. National Catheter Company standard, unmolded endotracheal tubes with both of the above types of cuffs, as well as Bivona Surgical Instruments Company "Kamen-Wilkinson" foam-filled cuffs (which are not actively inflated) were also ~ t u d i e d Fifty . ~ patients were randomly selected to be intubated with each of the five varieties of tubes and cuffs. All patients were similarly premedicated. Anesthesia was induced with thiopental, 3-4 mg/kg, and maintained with halothhne, 1-2 per cent, or enflurane, 1.5-3 per cent and nitrous oxide, 60 per cent, in oxygen. Following administration of succinylcholine, 1.5 mglkg, the tracheas were atraumatically intubated in the usual fashion. T h e endotracheal tubes were lubricated with lidocaine ointment, 5 per cent, and each had a plastic aluminum stylet in place during intubation. With the exception of the foam-filled cuffs, all cuffs were filled with air until the trachea was just
0~0~-3022/78/1200/0430 S00.G5 0 The Aincriciin Society of Anesthesiologists, Inc.
CIJNICAL REPOKI'S
of the effects of cyanide toxicity may be achieved by limiting the hourly or total close of SN1',0*i2by administration of tliiosulf~ite,':'.'"h yclroxocobalamin'" or cystine,"' although aclclitional studies are neeclecl to evaluate these methocls.
RI.:I:ERENCES
.
1 L;iriirits-Biirlciw P, Noriiiiil Gbl: Fiitiil ciiscs of' poisoning witli sotliuni iiitropriissitlc. Br hlctl J 2:407, 1!)4 I 2. .Jiick RD: 'I'osicity of' sotliuni ~iitrnl~r~tssitlc. Br J Anacstli 46: !)52, 1974
3. Mcrrificltl AJ, Bliiiitlcll hl D: 'I'osicity ol'soclium nitroprtissitlc, Br J Aiiiicstli 46:324. 1974 4, D:ivics D\\',Kiicliir D, Stcwiutl DJ, ct ;iI: A sutltlen clciith nssocintccl with tlic iisc of' soclium iiitroprussiclc for intluctioii of Iiy~~otciisioii diiring iiiincstlicsia. Can Annesth Soc 22:547-
552, 1975
\VR,01vcii M: Scvcrc nictiiliolic acidosis fnllowing hypotcnsioii inducctl with soclium nitroprussitlc. Br J
5 . bliicfiic
A ~ i i i c ~ t463795-797, li 1974 6. Dnvics D\\', Grciss L, Kiicliir D,ct id: Socliuni nitroprussiclc in cliiltlreii: Ol~ser\~iitions on iiicti~bolisnitluring norinid sntl itbi~t~r~iiid ICS\)OIISCS. Ciiii Aliiicsth SOC J 22:553-560, 1975 7. Cohcn S L I-Iypcrteiisioiiin rciiiil tr;insplant rccipicnis. Role of 1)iliitcriil ncplircctot~iy.Br hlctl J 3:78-81, 1973
8. l'ii~)iitlitiiitri~)\~ N, Cliisolin CD,Sliiicliinn~iR: I-Iypcrtcnsion in piticiits 011 rcgltliir hcniotliiilysis i1lid iif'tcr ~ e i i i iilloiraiis~l plaiiiation. Liincci 1302-906, 1969
9. Kiincko Y, Ikctlii -I., Tiikcda T': Rcnin rclcnsc during ncutc rctluctioii 0 1 iirtcrinl prcssiirc in norniotcnsivc siib&is and piiticnts with rciioviisciiliw hylicrtciision. J C h i lnvcst 46: 705-7 16, 1967 10. Piilnicr RF, Liissctcr KD:Sotliiun tiitropriissitlc. N Engl J Met1 292:294-297, 1975 11. McDowall DC. Kcniicy Nl', Turner J M , ct nl: The toxicity of sodium niiroprussitlc. Br J Anacstli 46:327-332, 1974 12. 'I'inkcr JI-I, Michciif'cltlcr JD: Socliuni tiitropriissitlc: Phnrniacology, ~oxicologynncl tlierapcutics. ANESTIIESIOLOGY 45: 340-354, 1976 13. Siiiitli RP: Cynnatc nntl tliiocyinatc: Aciitc toxicity. Proc Soc Exp Biol blctl 142:1041-1044, 1973 14. Smith RP, Kriiszynii I-I: Nitroprusside produces cynnidc poisoning viii ii rcsction with hcnioglobin. J Pliarnincol Exp Tlicr 191:557-5(i3, 1974 15. Luticr F, Diisolcil,'l rlch4ontgrosJ: Action clc I'hydroxocobnlaniitic ii tlosc niiissivc t h i s I'intoxicntion niguc nu cyiriiirc (;I tropos tl'un ciis). Arch tlcs Mnhtlics Profcssionclles dc blctlcciiic tlc Triiviiil ct clc Sccuritc Socinle 32683-688,
1971 16. \Vootl JL, Coolcy S L I~cioxicniioiiof cyiiiiitlc by cystinc. J Biol Clicni 2 I X:449-457, 1!)56
Ancsilicsiology
4 !):4:50-'1 32, I !I78
Postoperative Sore Throat -Importance of Endotracheal Tube Conformity Versus Cuff Design EDWARD A. LOESER,M.D.,*' RICHARD MACIIIN, D.D.S.,t JOEL COLLEY,M.D.,? DANIELORR, 11, D.D.S.,? GEORGEM. BEN NET'^, M.D.,$ TI-IEODORE H. STANLEY, M.D.# Recent investigations have suggested that both conformity of an endotracheal tube to the anatomic contour of the pharynx' ancl the design of the cuff2 may have profound effects on the incidence and magnitude of postoperative sore throat. In this study, endotracheal tube anatomic conformity was evaluated ancl comparecl with cuff design as a factor in the occurrence of postoperative sore throat.
M K ~ I - 1DS 0 Postoperative sore throat was evaluated i n 250 patients who had undergone abdominal or extremity operations. Patients had their tracheas intubated with 7.0-8.5-mm I D National Catheter Company
* Instructor i n Anesthesiology. Resiclent in Ancstlicsiology. $ Assistiitit l'rol'cssor of Ancstlicsiology. $ Associiitc Prof'cssor of' Aiicstliesiology/Siirgcry. Rcceivctl f'roiii thc Dcp;irtiiicnt of' Aiicstlicsiology,thc University of UIiIli Collcgc of' Mccliciiie, 50 North b1cdic;il Drive, Salt Lakc City, Utah 8~1132.Acccptctl for publication hliirch 10, 1978. Aclclrcss rcpriiit requests to Dr. Locser.
"Lindholm" pharyngeal molded endotracheal tubes with high-residual-volume, high-tracheal-contact, low-pressure cuffs or low-residual-volume,low-trachealcontact, higher-pressure cuffs. National Catheter Company standard, unmolded endotracheal tubes with both of the above types of cuffs, as well as Bivona Surgical Instruments Company "Kamen-Wilkinson" foam-filled cuffs (which are not actively inflated) were also ~ t u d i e d Fifty . ~ patients were randomly selected to be intubated with each of the five varieties of tubes and cuffs. All patients were similarly premedicated. Anesthesia was induced with thiopental, 3-4 mg/kg, and maintained with halothhne, 1-2 per cent, or enflurane, 1.5-3 per cent and nitrous oxide, 60 per cent, in oxygen. Following administration of succinylcholine, 1.5 mglkg, the tracheas were atraumatically intubated in the usual fashion. T h e endotracheal tubes were lubricated with lidocaine ointment, 5 per cent, and each had a plastic aluminum stylet in place during intubation. With the exception of the foam-filled cuffs, all cuffs were filled with air until the trachea was just
0~0~-3022/78/1200/0430 S00.G5 0 The Aincriciin Society of Anesthesiologists, Inc.
