Accepted Manuscript

Changes in endotracheal tube intracuff pressure and air leak pressure over time in
anesthetized Beagle dogs

Chi Won Shin, Won-gyun Son, Min Jang, Hyunseok Kim, Hyungjoo Han, Jeesoo Cha,
Inhyung Lee
PII: S1467-2987(18)30164-8
DOI: 10.1016/j.vaa.2018.06.005
Reference: VAA 285

To appear in: Veterinary Anaesthesia and Analgesia

Received Date: 27 December 2017

Revised Date: 24 June 2018
Accepted Date: 24 June 2018

Please cite this article as: Shin CW, Son W-g, Jang M, Kim H, Han H, Cha J, Lee I, Changes in
endotracheal tube intracuff pressure and air leak pressure over time in anesthetized Beagle dogs,
Veterinary Anaesthesia and Analgesia (2018), doi: 10.1016/j.vaa.2018.06.005.

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 ACCEPTED MANUSCRIPT

RESEARCH PAPER

Running head (Authors): CW Shin et al.

Running head (short title): Endotracheal tube cuff pressure over time

Changes in endotracheal tube intracuff pressure and air leak pressure over time in

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anesthetized Beagle dogs

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Chi Won Shina, Won-gyun Sona, Min Janga,b, Hyunseok Kima, Hyungjoo Hana, Jeesoo Chaa &

Inhyung Leea

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Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Seoul National

University, Seoul, South Korea

b

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Ian Animal Diagnostic Imaging Center, Seoul, South Korea
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Correspondence: Inhyung Lee, Department of Veterinary Clinical Sciences, College of
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Veterinary Medicine, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 08826, South
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Korea. E-mail: inhyunglee@snu.ac.kr

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Abstract

Objective To evaluate endotracheal tube intracuff pressure (Pcuff) changes over time and the
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effect of these changes on air leak pressure (Pleak).

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Study design Prospective experimental study.

Animals A group of nine healthy adult Beagle dogs.

Methods In part I, in vitro measurements of Pcuff were recorded for 1 hour in eight endotracheal

tubes subjected to four treatments: room temperature without lubricant (RT0L), room
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temperature with lubricant (RTWL), body temperature without lubricant (BT0L), and body

temperature with lubricant (BTWL). In part II, nine dogs were endotracheally intubated and Pleak

was evaluated at Pcuff of 25 mmHg. Subsequently, Pcuff was reset to 25 mmHg (baseline) and Pcuff

measurements were recorded every 5 minutes for 1 hour. Afterwards, a second Pleak

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measurement was recorded at the current Pcuff. The data were analyzed using Wilcoxon signed

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ranks test, repeated measures ANOVA and Mann-Whitney U test.

Results In part I, Pcuff differed significantly between the RT0L and RTWL treatments at 5–60

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minutes, and between the BT0L and BTWL treatments at 5–35, 55 and 60 minutes (p < 0.05). In

part II, compared with baseline pressures, mean Pcuff decreased to <18 mmHg at 10 minutes and

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significant decreases were recorded at 15–60 minutes (Pcuff range 10.0 ± 4.9 to 13.4 ± 6.3 mmHg,
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mean ± standard deviation). Significant differences were observed between the first and second
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Pleak measurements (p = 0.034). Pleak decreased in six of nine dogs, was not changed in two dogs

and increased in one dog.

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Conclusions and clinical relevance Significant decreases in Pcuff over time were measured. Pleak
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may decrease during anesthesia and increase the risk for silent pulmonary aspiration. The results

indicate the need for testing Pcuff more than once, especially at 10 minutes after the onset of
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anesthesia.
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Keywords air leak pressure, dog, endotracheal tube, intracuff pressure, time.
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Introduction

Endotracheal intubation is a crucial element of anesthesia, critical care and emergency

medicine in both human and veterinary medicine. Intubation with a cuffed endotracheal tube is

regularly performed during small animal anesthesia to maintain a patent airway, deliver volatile

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anesthetics and oxygen, enable positive pressure ventilation, protect the airway from aspiration

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of fluids and prevent exposure of personnel to waste anesthetic gases (Mosley 2011; Briganti et

al. 2012; Muir et al. 2013). After intubation, the cuff should be inflated to achieve an airtight seal

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between the cuff and trachea without impeding tracheal blood flow (Stewart et al. 2003).

Because the tracheal mucosal perfusion pressure ranges 25–35 mmHg, intracuff pressures (Pcuff)

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of 20–25 mmHg will generally not impede blood flow through the tracheal mucosa (Verma 2006;
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Hartsfield 2007). Within this pressure range, the cuff should be able to maintain an airtight seal

at airway pressures of 15–22 mmHg (20–30 cmH2O; Mosley 2015). Pcuff <18 mmHg increases
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the risk for aspiration whereas pressures >35 mmHg compromise capillary blood flow, which
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may lead to various perioperative complications such as inflammation of the tracheal wall,
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ischemia/necrosis of the tracheal mucosa or, in extreme cases, tracheal rupture (Dugdale 2010;

Thomas & Lerche 2011; Muir et al. 2013; Mosley 2015).

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Although Pcuff may be checked initially after cuff inflation following endotracheal

intubation, the pressure within the cuff is a dynamic process that can be affected by alterations in
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the shape and size of the trachea, body temperature, variations in head and neck position and the
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anesthetic gas mixture (Kako et al. 2015). Several studies in human medicine revealed that Pcuff

decreases over time in critically ill patients intubated for prolonged periods (Nseir et al. 2009;

Sole et al. 2009, 2011). In veterinary medicine, it has been recommended that cuff inflation be

checked again after 15 or 30 minutes of anesthesia because the tracheal diameter may change
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due to muscle relaxation (Thomas & Lerche 2011). However, no objective standard exists for

Pcuff monitoring. Therefore, the aim of this study was to evaluate changes in Pcuff over time, to

determine which factors influence Pcuff and whether these changes affect the ability of the

endotracheal tube to maintain an airtight seal. The hypothesis was that Pcuff would decrease over

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time and by doing so the decrease in Pcuff would result in an inadequate seal between the cuff and

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trachea.

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Materials and methods

Part I. In vitro measurements of Pcuff

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Using a crossover model, eight newly opened 7.5 mm internal diameter polyvinyl
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chloride endotracheal tubes (RUSCH super safety clear 112482; Teleflex Medical, NC, USA)

were studied under four treatment conditions: 1) room temperature (20–25 °C) without lubricant
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(RT0L); 2) room temperature with lubricant (RTWL); 3) body temperature (37.3–39 °C) without
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lubricant (BT0L); and 4) body temperature with lubricant (BTWL). After each experiment, the
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tube was washed with water to remove lubricant and air dried. All eight tubes underwent each of

the four treatments with a 3-day interval between each treatment. The order of the treatments was
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randomly chosen by writing the treatment names on pieces of paper and blindly drawing lots.

The endotracheal tube cuff was fully deflated and the tube was inserted into a 10 mL syringe
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barrel (Kovax-syringe 10 mL; Korea Vaccine Co. Ltd, Korea) with an inner diameter of 14.5 mm
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and Pcuff was continuously measured for 1 hour (Video clip S1). Prior to each treatment, the

endotracheal tube was checked for leaks caused by defective products by inflating the cuff with

air (17–18 mL) for 5 minutes followed by deflation. If the same amount of air was removed, it

was judged that the cuff was intact. Room temperature (20–25 °C) was continuously monitored
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and recorded every 5 minutes using two devices: 1) a mercury thermometer and 2) the

temperature probe from the multi-parameter monitor (Datex-Ohmeda S/5; GE Healthcare,

Finland) that were placed vertically near the endotracheal tube. Body temperature (37.3–39.0 °C)

was achieved and maintained by placing the outlet of a warm air device (Bair hugger; 3M, MN,

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USA) into a 50 L plastic bag and measuring the temperature with a mercury thermometer and the

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temperature probe of the multi-parameter monitor. The mercury thermometer and temperature

probe were placed vertically through a small hole and with the tips placed inside the plastic bag

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containing the endotracheal tube temperature was continuously monitored and recorded every 5

minutes. For the lubricant treatments, 2 mL of water-soluble gel lubricant containing

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chlorhexidine (Silgreen Cream; Firson Co. Ltd, Korea) was generously applied to the cuff before
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inserting the endotracheal tube into the syringe barrel. Prior to starting the continuous Pcuff
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measurements, each endotracheal tube was acclimatized to the selected temperature (room or

body temperature) for 5 minutes.

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Using a previously described and validated technique to continuously measure Pcuff, the
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pilot balloon of the endotracheal tube was connected to a pressure transducer (Transpac IV

Monitoring Kit; ICU Medical Inc., CA, USA) via a 3-way stopcock (Gopalakrishnan et al. 2013;
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Krishna et al. 2014). The pressure transducer was connected to a multi-parameter monitor

(Datex-Ohmeda S/5; GE Healthcare) and was zeroed to room pressure before Pcuff was measured.
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Air was injected through the pilot balloon to increase Pcuff to 25 mmHg using a syringe that was
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connected to the 3-way stopcock. After a stabilization period of 2 minutes, baseline Pcuff was set

to 25 mmHg and Pcuff measurements were recorded every 5 minutes for 1 hour.

Part II. In vivo measurements of Pcuff

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Animals

This study was approved by the Institutional Animal Care and Use Committee of Seoul

National University (SNU-170529-1). A group of nine adult male Beagle dogs [mean ± standard

deviation (SD) age 4.0 ± 1.0 years] were included in this study. All dogs were considered to be

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clinically healthy based on physical examination, complete blood count, serum chemistry

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analysis and thoracic and abdominal radiographs. Body condition score was assessed using a 9

point scoring system (Laflamme 1997).

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Anesthetic protocol and measurements of resistance and air leak pressure (Pleak)

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Food was withheld for 12 hours before anesthesia but water was available ad libitum. All
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dogs were aseptically catheterized in a cephalic vein using a 22 gauge over-the-needle catheter

(Sewoon Medical Co. Ltd, Korea). Medetomidine (5 µg kg−1; Domitor; Zoetis, NJ, USA) was
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administered intravenously (IV) for premedication and anesthesia was induced with alfaxalone
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(2 mg kg−1; Alfaxan; Jurox Pty Ltd, Australia) administered IV. Hartmann’s solution (H/S;
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Daihan Pharmaceutical Co. Ltd, Korea) was administered at a rate of 10 mL kg−1 hour−1

throughout the experiment. Anesthesia was maintained with isoflurane (Ifrane; Hana Pharm Co,
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Ltd, Korea) in >95% oxygen using a rebreathing circle system (Multiplus MEVD Anesthesia

Machine; Royal Medical, Korea). The oxygen flowmeter was set at 2 L minute−1 and the
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vaporizer at 2.0% for the duration of the experiment. The dogs breathed spontaneously during
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the procedure. An electrocardiogram, respiratory rate (fR), arterial hemoglobin oxygen saturation

by pulse oximetry, oscillometric arterial blood pressure, end-tidal carbon dioxide tension by

capnometry and end-tidal isoflurane concentration (FE´Iso) were monitored throughout the

experiment (FI/Carescape Monitor B650; GE Healthcare). Normothermia (37.3–39.0 °C) was

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maintained using a warm water blanket (HTP-1500 Heat Therapy Pump; Adroit Medical

Systems, TN, USA).

Endotracheal tube size was determined using a previously described method of

measuring the internal tracheal diameter from a thoracic radiographic image taken with the

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awake dog in right lateral recumbency (Shin et al. 2018). Newly opened endotracheal tubes were

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used for every dog and all tubes were checked for leaks and lubricated using the same product as

in part I prior to intubation. Dogs were endotracheally intubated in sternal recumbency by one

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experienced investigator (HK) who scored the resistance of endotracheal tube passage through

the trachea (0, no resistance; 1, mild resistance; 2, moderate resistance; 3, severe resistance). If

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moderate or severe resistance was noted during intubation, the endotracheal tube was exchanged
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for one that was 0.5 mm smaller. After intubation, the dogs were positioned in dorsal

recumbency and a ventrodorsal fluoroscopic image of the thorax was taken (Spinel 3G Mobile
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Surgical Fluoroscopic X-ray System; GEMSS Medical, Korea). The endotracheal tube was
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deemed to be in the correct position if the distal tip was located at the cranial border of the
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thoracic inlet.

Pcuff was continuously measured as in part I. Using a 5 mL syringe that was connected to
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the 3-way stopcock, air was added to the cuff through the pilot balloon to obtain a Pcuff of 25

mmHg. Subsequently, a Pleak measurement was performed within 5 minutes of intubation by

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increasing the oxygen flowmeter to 5 L minute−1 and closing the adjustable pressure limiting
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valve. As pressure within the circle system increased, the peak inspiratory pressure at which an

air leak was audible using a stethoscope placed just cranial to the thoracic inlet was recorded by

one investigator (HK). As soon as circle pressure reached 25 cmH2O (18.4 mmHg), the

adjustable pressure limiting valve was opened to prevent pulmonary barotrauma. If no audible
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leak was detected at circle pressure of 25 cmH2O, Pleak was recorded as >25 cmH2O. If Pleak was

<20 cmH2O, the animal was extubated and re-intubated with an endotracheal tube that was 0.5

mm larger. After Pleak was measured, a stabilization period of 2 minutes was allowed before

continuous Pcuff measurements were taken.

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Continuous measurement of Pcuff

Baseline Pcuff was set to 25 mmHg and Pcuff measurements were taken every 5 minutes for

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1 hour. Then, a second Pleak measurement, in addition to the one recorded within 5 minutes of

endotracheal intubation, was taken at the current Pcuff before the vaporizer was turned off and the

dog was allowed to recover from anesthesia.

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Statistical analyses
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The data were analyzed using the SPSS 22 statistical program (SPSS Inc., IL, USA). Data
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on Pcuff and Pleak are presented as mean ± SD. The Wilcoxon signed ranks test was used to
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evaluate differences in Pcuff between the in vitro treatments. One-way analysis of variance with

repeated measures was used to evaluate changes in Pcuff over time and post hoc analysis was
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performed using the Bonferroni-Holm method. Differences in Pcuff between the part I BTWL

treatment and part II were evaluated using the Mann-Whitney U test. The change in Pleak from
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part II baseline and after an hour of anesthesia was analyzed using the Wilcoxon signed ranks
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test. A p-value < 0.05 was considered to be statistically significant.

Results

Part I. In vitro study

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There were significant differences in Pcuff between the RT0L and RTWL treatments at all

time points except for the baseline measurement (p < 0.05; Fig. 1). Significant differences in Pcuff

between the BT0L and BTWL treatments were observed at 5–35, 55 and 60 minutes (p < 0.05;

Fig. 1). No significant differences in Pcuff were noted between RT0L and BT0L or RTWL and

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BTWL at any time point (p > 0.05). In all treatments, significant decreases in Pcuff were observed

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at 5–60 minutes compared with baseline (p < 0.05; Fig. 1).

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Part II. In vivo study

The dogs weighed 11.0 ± 1.2 kg (mean ± SD) and body condition scores were median 4

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(range, 4–6). All tracheas were determined to be normal based on thoracic radiographs.
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Pcuff decreased over time in all endotracheal tubes and was significantly decreased from

baseline at 15–60 minutes (p < 0.05; Fig. 2). No significant differences in Pcuff were identified
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between the in vivo measurements and the BTWL treatment (p > 0.05).
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Pleak and Pcuff measured at 60 minutes were significantly decreased from baseline (p =
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0.034, p < 0.05, respectively; Table 1). Pleak was decreased in six of nine (66.6%) dogs, was not

changed in two of nine (22.2%) dogs and increased in one (11.1%) dog. At the beginning of
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anesthesia, moderate resistance to endotracheal tube insertion was noted in one dog and Pleak was

<20 cmH2O in one dog; therefore, a 0.5 mm smaller and larger endotracheal tubes were used for
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re-intubation, respectively.
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The FE´Iso and fR (mean ± SD) at the start and end of the 60 minutes was 1.0 ± 0.2%, 1.6

± 0.1%, 8 ± 4 breaths minute−1 and 13 ± 4 breaths minute−1, respectively. Hypotension (mean

arterial blood pressure 54–59 mmHg) was observed in four dogs but recovered to >60 mmHg

within 15 minutes. No adverse complications of the hypotensive episodes or from endotracheal

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intubation were observed. All dogs recovered in the same condition in which they started and

were returned to the research colony upon completion of the experiment.

Discussion

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The aim of this study was to evaluate changes in Pcuff over time and how these changes

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affected Pleak. The results of this study showed that Pcuff significantly decreases over time and

that Pleak may or may not decrease with declining Pcuff.

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After intubation with a cuffed endotracheal tube, the cuff should be able to achieve an

airtight seal when inflated to pressures of 20–25 mmHg (Mosley 2015). Generally, Pcuff is

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measured once following endotracheal intubation. However, the pressure within the cuff is a
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dynamic process that is influenced by various factors. The results of the present study revealed

that Pcuff significantly decreases over time without intervention. This result is consistent with
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previous studies where Pcuff was intermittently and continuously monitored in critically ill
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patients under mechanical ventilation (Sole 2002; Sole et al. 2002, 2009, 2011; Nseir et al. 2009).
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Alterations in Pcuff have been attributed to various factors, including the design of the cuff,

anesthetic depth, head and neck position, body temperature, anesthetic gas mixture and the use of
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neuromuscular blocking drugs (Girling et al. 1999; Sole et al. 2009; Kako et al. 2015). Previous

studies have shown that hypothermia, head extension and neuromuscular blockade lead to
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decreases in Pcuff (Girling et al. 1999; Neto et al. 1999; Kako et al. 2015), while head and neck
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flexion and the presence of nitrous oxide within the anesthetic gas mixture lead to increases in

Pcuff (Stanley et al. 1974; Kako et al. 2015). The results of the present in vitro study revealed that

Pcuff decreases similarly at both room and body temperature (decreased by 4.6 and 5.1 mmHg

after 1 hour, respectively) when the cuff is not lubricated. Pcuff also decreased over time in vitro
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despite a study design that eliminated temperature, head and neck position and neuromuscular

blockade as influencing factors.

The results of this study indicate that the decrease in Pcuff over time may be influenced by:

1) the inherent properties of the cuff, 2) the use of a lubricant and 3) tracheal muscle relaxation.

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First, the decrease in Pcuff observed in vitro in the nonlubricated tubes at both room and body

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temperatures may be attributed to the elastic properties of the cuff itself, similar to that of a

balloon. Second, cuff lubrication significantly decreased Pcuff at both room and body temperature

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(decreased by 11.4 and 10.3 mmHg after 1 hour, respectively). One possible explanation is that

the plastic cuff was softened by the use of a lubricant compared with the nonlubricated tubes.

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Finally, when compared with the in vitro study, the additional decrease in Pcuff observed during
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the in vivo study (decreased by 14.1 mmHg after 1 hour) may be attributed to the relaxation of

the tracheal muscle during anesthesia. In this study, anesthetic depth was assessed using fR and
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FE´Iso. The FE´Iso increased during the first 10–15 minutes but then remained relatively constant
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during 20–60 minutes, while fR nonsignificantly increased towards the end of the 1 hour
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observation time. The increase in FE´Iso may have resulted in an increase in muscle relaxation

surrounding the trachea thus resulting in a decrease in Pcuff. Tracheal diameter could have been
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influenced by the waning effects of the sedative and induction drugs and the increased uptake of

isoflurane. Further studies assessing the relationship between tracheal muscle tone and Pcuff are
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warranted.
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Pcuff may also be influenced by the depth of the endotracheal tube within the trachea. A

previous study showed that endotracheal tubes that were placed deeper into the trachea were

associated with a greater incidence of lower Pcuff (Sole et al. 2009). In human medicine, it is

suggested that the distal tip of the endotracheal tube be located in the middle third of the trachea
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(Dorsch & Dorsch 1984). In veterinary medicine, a recommendation is that the distal tip of the

endotracheal tube should not extend beyond the thoracic inlet (Clarke et al. 2014). In the present

study, all dogs were intubated to the level of the thoracic inlet. A future study in dogs is needed

to evaluate the impact of different depths of endotracheal tube insertion on Pcuff.

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Inflation of the endotracheal tube cuff to 18–25 mmHg should prevent leaks around the

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tube at airway pressures of 20–30 cmH2O (Thomas & Lerche 2011; Mosley 2015). Another

study in children revealed that Pleak was unaffected by the rate of fresh gas flow into the

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breathing system or by varying endotracheal tube depth within the trachea (Finholt et al. 1985).

However, muscle relaxation from administration of a neuromuscular blocking agent resulted in

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significantly lower Pleak (increased leaking) compared with full recovery from neuromuscular
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blockade (Finholt et al. 1985). In the present study, a significant change in Pleak was noted after 1

hour of anesthesia, with decreases observed in six of nine (66.6%) dogs. It is possible that
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muscle relaxation was greater at 1 hour than baseline measurement performed within 10 minutes
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of induction of anesthesia. Audible leaks and triggering of the ventilator alarm are generally
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considered to be indicators of a cuff leak. Some may argue that the cuff provides an adequate

seal if these issues are not observed (Sole et al. 2009). Nonetheless, it has been shown that even
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though a leak is not clinically observed, underinflation of the endotracheal tube cuff may be

associated with silent aspiration (Nseir et al. 2009). Specifically, there is evidence for a high risk
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of aspiration when Pcuff is <18 mmHg; 25 cmH2O (Verma 2006; Mosley 2011, 2015). The results
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of the present study suggest that at 10 minutes of anesthesia, when Pcuff decreased to <18 mmHg,

the animal may be at increased risk for silent aspiration.

In human medicine, current textbooks recommend that Pcuff be measured and adjusted

approximately 10 minutes after endotracheal intubation to allow for softening of the cuff
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material according to body temperature and because the occlusive volume will vary with muscle

tone (Dorsch & Dorsch 2008). In veterinary medicine, it is recommended that cuff inflation be

checked approximately 15 or 30 minutes after the onset of anesthesia because tracheal diameter

may change due to muscle relaxation (Thomas & Lerche 2011). The results of this study further

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strengthen the recommendation for additional monitoring of Pcuff, especially 10 minutes after

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intubation.

There are several limitations to this study. The first limitation is related to the small

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sample size. A larger sample size would provide greater statistical significance and more precise

results. The second limitation is that two dogs needed to be re-intubated owing to moderate

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resistance of endotracheal tube passage through the trachea and inadequate seal, respectively.
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However, it is unlikely that changing the endotracheal tube size would have a significant impact

on the overall trend in Pcuff change. A third limitation is that only one type of lubrication method
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was used in this study. Future studies comparing the effects of different lubrication methods
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(water and other available formulations of lubricant) on Pcuff in both the in vitro and in vivo
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setting would be informative. Another limitation is that mild hypotension was observed in four

dogs, which could have affected tracheal mucosal perfusion pressures. Although no clinical
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complications with respect to the hypotensive episodes was observed, it is difficult to ascertain

that no tracheal mucosal damage occurred because bronchoscopy was not performed to confirm
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the absence of tracheal damage. Finally, in the present study, to prevent pulmonary barotrauma,
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the adjustable pressure limiting valve was opened when circle pressure reached 25 cmH2O. If no

leak was detected at this pressure, the Pleak was recorded as >25 cmH2O. Exclusion of these dogs

may have shown differing results. However, in the present study, Pleak of 25 cmH2O was
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recorded in one dog at baseline and in another dog at 1 hour. Therefore, if the actual Pleak were

estimated, the values are unlikely to significantly alter the results.

In conclusion, the results of this study suggest that clinically significant decreases in Pcuff

can be expected over time. Although Pleak may not change to the same degree as Pcuff, Pcuff may

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decrease to <18 mmHg which is proposed as increased risk for silent aspiration. Therefore, the

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results of this study support the need for continuous monitoring of Pcuff during anesthesia.

However, in cases where continuous monitoring is not feasible, intermittent monitoring of Pcuff,

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and specifically at 10 minutes after the onset of anesthesia, is strongly recommended.

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Acknowledgements

This research was supported by the Basic Science Research Promotion program through the
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National Research Foundation (NRF) of Korea, as funded by the Ministry of Education, Science,
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and Technology (NRF- 2016R1D1A1A09919546), and the BK21 PLUS program and the
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Research Institute for Veterinary Science, College of Veterinary Medicine, Seoul National

University.
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Authors’ contributions
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CWS: study design, acquisition of data, data management, interpretation of data, statistical
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analysis, preparation of manuscript; W-gS and MJ: study design, interpretation of data, revision

of manuscript; HK: acquisition of data, revision of manuscript; HH and JC: acquisition of data,

data management; IL: study design, interpretation of data, revision of manuscript. All authors

approved the final manuscript.

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Conflict of interest statement

Authors declare no conflict of interest.

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Supporting information
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Additional supporting information related to this article can be found at https:

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Video clip S1. In vitro measurement of intracuff pressures.

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Table 1 Air leak pressures (cmH2O and conversion to mmHg; 1 cmH2O = 0.736 mmHg) and the

corresponding intracuff pressures (mmHg) obtained within 5 minutes after endotracheal

intubation (T0) and after 60 minutes of anesthesia (T60) in nine Beagle dogs anesthetized with

medetomidine, alphaxalone and isoflurane. The endotracheal tube intracuff pressure was set at

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25 mmHg at T0.

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Measurement time Air leak pressure Intracuff pressure

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(minutes) (mmHg)
(cmH2O) (mmHg)

T0 21.2 ± 2.0 15.6 ± 1.5 25.0 ± 0.0

T60 18.8 ± 3.3*

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Data are mean ± standard deviation. *Significantly different from T0 (p < 0.05).
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Figure 1 Change in intracuff pressures (mean ± standard deviation) at time 0 (baseline; cuff

inflation to 25 mmHg) and for 60 minutes in eight endotracheal tubes (7.5 mm internal diameter)

placed inside the barrel of a 10 mL syringe. In 4 experiments, the pressures were measured at

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room temperature (RT) or body temperature (BT) and with cuff lubricant applied (WL) or

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without lubricant (0L).

RT0L, room temperature without lubricant; RTWL, room temperature with lubricant; BT0L,

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body temperature without lubricant; BTWL, body temperature with lubricant.
*
Significant difference between RT0L and RTWL (p < 0.05). †Significant difference between

BT0L and BTWL (p < 0.05).

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Figure 2 Changes in endotracheal tube intracuff pressures (mean ± standard deviation) for the
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first 60 minutes following endotracheal intubation in nine Beagle dogs administered

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medetomidine, alphaxalone and isoflurane. At time 0 (baseline) the endotracheal tube cuff was
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inflated to 25 mmHg.
*
Significantly different from baseline (p < 0.05).
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