This adds to the growing evidence to support the use of the LOR syringe for ETT cuff pressure estimation. Charles Kojjo, Agnes Wabule, and Nodreen Ayupo were responsible for patient recruitment and data collection and analysis. We intentionally avoided this approach since our purpose was to evaluate cuff pressures and associated volumes in three routine clinical settings. Apropos of a case surgically treated in a single stage]. Even with a 'good' cuff seal, there is still a risk of micro-aspiration (Hamilton & Grap, 2012), especially with long-term ventilation in the . 1996-2023, The Anesthesia Patient Safety Foundation, APSF Patient Safety Priorities Advisory Groups, Pulse Oximetry and the Legacy of Dr. Takuo Aoyagi, APSF Prevencin y Manejo de Fuegos Quirrgicos, APSF Prvention et gestion des incendies dans les blocs opratoires, Monitoring for Opioid-Induced Ventilatory Impairment (OIVI), Perioperative Visual Loss (POVL) Informed Consent, ASA/APSF Ellison C. Pierce, Jr., MD Memorial Lecturers, The APSF: Ten Patient Safety Issues Weve Learned from the COVID Pandemic, APSF Technology Education Initiative (TEI), Emergency Manuals Implementation Collaborative (EMIC), Perioperative Multi-Center Handoff Collaborative (MHC), APSF/FAER Mentored Research Training Grant, Investigator Initiated Research (IIR) Grants, Past APSF Consensus Conferences and Recommendations, Conflict in the Operating Room: Impact on Patient Safety Report from the ASA 2016 Annual Meetings APSF Workshop, Distractions in the Anesthesia Work Environment: Impact on Patient Safety. Perioperative Handoffs: Achieving Consensus on How to Get it Right, APSF Website Offers Online Educational DVDs, APSF Announces the Procedure for Submitting Grant Applications, Request for Applications (RFA) for the Safety Scientist Career Development Award (SSCDA), http://www.asahq.org/~/media/sites/asahq/files/public/resources/standards-guidelines/statement-on-standard-practice-for-infection-prevention-for-tracheal-intubation.pdf. An endotracheal tube : provides a passage for gases to flow between a patients lungs and an anaesthesia breathing system . In this cohort, aspiration had the second highest incidence of primary airway-related serious events [6]. How do you measure cuff pressure? Used by Google DoubleClick and stores information about how the user uses the website and any other advertisement before visiting the website. The manual method used a pressure manometer to adjust pressure at cruising altitude and after landing. Patients with emergency intubations, difficult intubations, or intubation performed by non-anesthesiology staff; pregnant women; patients with higher risk for aspiration (e.g., full stomach, history of reflux, etc. Only 27% of pressures were within 2030 cmH2O; 27% exceeded 40 cmH2O. supported this recommendation [18]. 1). We designed this study to observe the practices of anesthesia providers and then determine the volume of air required to optimize the cuff pressure to 20 cmH2O for various sizes of endotracheal tubes. This point was observed by the research assistant and witnessed by the anesthesia care provider. Findings from this study were in agreement, with 25.3% of cuff pressures in the optimal range after estimation by the PBP method. This is the routine practice in all three hospitals. By clicking Accept, you consent to the use of all cookies. However, these are prohibitively expensive to acquire and maintain in many operating theaters, and as such, many anesthesia providers resort to subjective methods like pilot balloon palpation (PBP) which is ineffective [1, 2, 1620]. This cookie is used to a profile based on user's interest and display personalized ads to the users. All authors read and approved the final manuscript. Neither patient morphometrics, institution, experience of anesthesia provider, nor tube size influenced measured cuff pressure (35.3 21.6 cmH2O). Only two of the four research assistants reviewed the patients postoperatively, and these were blinded to the intervention arm. 101, no. The loss of resistance syringe was then detached, the VBM manometer was attached, and the pressure reading was recorded. Currently, in critical care settings, patients are intubated with ETT comprising high-volume low-pressure cuffs. Related cuff physical characteristics. The study would be discontinued if 5% of study subjects in one study group experienced an adverse event associated with the study interventions as determined by the DSMB, or if a value of <0.001 was obtained on an interim analysis performed halfway through patient accrual. This study shows that the LOR syringe method is better at estimating cuff pressures in the optimal range when compared with the PBP method but still falls short in comparison to the cuff manometer. How to insert an endotracheal tube (intubation) for doctors and medical students, Video on how to insert an endotracheal tube, AnaestheticsIntensive CareOxygenShortness of breath. One hundred seventy-eight patients were analyzed. Use low cuff pressures and choosing correct size tube. CAS This study was not powered to evaluate associated factors, but there are suggestions that the levels of anesthesia providers with varying skill set and technique at direct laryngoscopy may be associated with a high incidence of complications. Underinflation increases the risk of air leakage and aspiration of gastric and oral pharyngeal secretions [4, 5]. But opting out of some of these cookies may have an effect on your browsing experience. Article Curiel Garcia JA, Guerrero-Romero F, Rodriguez-Moran M: [Cuff pressure in endotracheal intubation: should it be routinely measured?]. Previous studies suggest that this approach is unreliable [21, 22]. Nitrous oxide and medical air were not used as these agents are unavailable at this hospital. 32. Endotracheal tubes are widely used in pediatric patients in emergency department and surgical operations [1]. . 106, no. 1984, 24: 907-909. This cookie is set by Youtube and registers a unique ID for tracking users based on their geographical location. 139143, 2006. 4, pp. Tracheal cuff seal, peak centering and the incidence of postoperative sore throat]. First, inflate the tracheal cuff and deflate the bronchial cuff. . Statement on the Standard Practice for Infection Prevention and Control Instruments for Tracheal Intubation. This is a standard practice at these hospitals. 6, pp. After deflating the cuff, we reinflated it in 0.5-ml increments until pressure was 20 cmH2O. 288, no. We also appreciate the statistical analysis by Gilbert Haugh, M.S., and the editorial assistance of Nancy Alsip, Ph.D., (University of Louisville). P. Sengupta, D. I. Sessler, P. Maglinger et al., Endotracheal tube cuff pressure in three hospitals, and the volume required to produce an appropriate cuff pressure, BMC Anesthesiology, vol. Anesthetists were blinded to study purpose. On the other hand, overinflation may cause catastrophic complications. The data were exported to and analyzed using STATA software version 12 (StataCorp Inc., Texas, USA). Product Benefits. PubMedGoogle Scholar. These data suggest that tube size is not an important determinant of appropriate cuff inflation volume. Low pressure high volume cuff. Tracheal Tube Cuff. 111, no. To achieve the optimal ETT cuff pressure of 2030cmH2O [3, 8, 1214], ETT cuffs should be inflated with a cuff manometer [15, 16]. 66.3% (59/89) of patients in the loss of resistance group had cuff pressures in the recommended range compared with 22.5% (20/89) from the pilot balloon palpation method. L. Gilliland, H. Perrie, and J. Scribante, Endotracheal tube cuff pressures in adult patients undergoing general anaesthesia in two Johannesburg Academic Hospitals, Southern African Journal of Anaesthesia and Analgesia, vol. Copyright 2013-2023 Oxford Medical Education Ltd. Myasthenia Gravis (MG) Neurological Examination, Questions about DVT (Deep Vein Thrombosis), Endotracheal tube (ETT) insertion (intubation), Supraglottic airway (e.g. 2001, 137: 179-182. 208211, 1990. The tube is kept in place by a small cuff of air that inflates around the tube after it is inserted. The patient was maintained on isoflurane (11.8%) mixed with 100% oxygen flowing at 2L/min. If using an adult trach, draw 10 mL air into syringe. Conclusion. 10.1055/s-2003-36557. 1981, 10: 686-690. This outcome was compared between patients with cuff pressures from 20 to 30cmH2O range and those from 31 to 40cmH2O following the initial correction of cuff pressures. These cookies will be stored in your browser only with your consent. We recommend that ET cuff pressure be set and monitored with a manometer. Circulation 122,210 Volume 31, No. 36, no. D) Pressure gauge attached to pilot balloon of defective cuff with reading of 30 mmHg with cuff not appropriately inflated. 6, pp. If the silicone cuff is overinflated air will diffuse out. However, less serious complications like dysphagia, hoarseness, and sore throat are more prevalent [911]. The loss of resistance syringe was then detached, the VBM manometer was attached, and the pressure reading was recorded. However you may visit Cookie Settings to provide a controlled consent. 10, pp. chest pain or heart failure. Seegobin RD, van Hasselt GL: Endotracheal cuff pressure and tracheal mucosal blood flow: endoscopic study of effects of four large volume cuffs. Upon closer inspection of the ETT that had been removed from the airway, there appeared to be a defect in which the air injected into the pilot balloon did not reach the cuff (see Figures 1 and 2). Cuff Pressure Measurement Check the cuff pressure after re-inflating the cuff and if there are any concerns for a leak. On the other hand, high cuff pressures beyond 50cmH2O were reduced to 40cmH2O. 48, no. Experienced emergency medicine physicians cannot safely inflate or estimate endotracheal tube cuff pressure using standard techniques. Cuff pressure can be easily measured with a small aneroid manometer [23], but this device is not widely available in the United States. allows one to provide positive pressure ventilation. H. Jin, G. Y. Tae, K. K. Won, J. This was a randomized clinical trial. Using a laryngoscope, tracheal intubation was performed, ETT position confirmed, and secured with tape within 2min. The cookie is created when the JavaScript library executes and there are no existing __utma cookies. 2, pp. We use this to improve our products, services and user experience. The cookies store information anonymously and assign a randomly generated number to identify unique visitors. Inflate the cuff with 5-10 mL of air. Intubation was atraumatic and the cuff was inflated with 10 ml of air. Uncommon complication of Carlens tube. CRNAs (n = 72), anesthesia residents (n = 15), and anesthesia faculty (n = 6) performed the intubations. B) Dye instilled into the defective endotracheal tube stops at the entrance of the pilot balloon tubing into the main tubing (arrow in Figure 2A and 2B). 686690, 1981. studied the relationship between cuff pressure and capillary perfusion of the rabbit tracheal mucosa and recommended that cuff pressure be kept below 27 cm H2O (20 mmHg) [19]. 2023 BioMed Central Ltd unless otherwise stated. The incidence of postextubation airway complaints after 24 hours was lower in patients with a cuff pressure adjusted to the 2030cmH2O range, 57.1% (56/98), compared with those whose cuff pressure was adjusted to the 3040cmH2O range, 71.3% (57/80). Inflation of the cuff of . Data are presented as means (SD) or medians [interquartile ranges] unless otherwise noted; P < 0.05 was considered statistically significant. The integrity of the entire breathing circuit and correct positioning of the ETT between the vocal cords with direct laryngoscopy were confirmed. 3, pp. Remove the laryngoscope while holding the tube in place and remove the stylet from the tube. 87, no. It helps us understand the number of visitors, where the visitors are coming from, and the pages they navigate. S1S71, 1977. The tube will remain unstable until secured; therefore, it must be held firmly until then. Google Scholar. COPD, head injury, ARDS), Rapid sequence induction (RSI) intubation, Procedural variation using rapid anaesthetisation with cricoid pressure to prevent aspiration while airway is quickly secured, Used for patients at risk of aspiration e.g. D) Pressure gauge attached to pilot balloon of defective cuff with reading of 30 mmHg with cuff not appropriately inflated. Upon inflation, folds form along the cuff surface, and colonized oropharyngeal secretions may leak through these folds. "Aire" indicates cuff to be filled with air. In low- and middle-income countries, the cost of acquiring ($ 250300) and maintaining a cuff manometer is still prohibitive. Standard cuff pressure is 25mmH20 measured with a manometer. 6422, pp. A total of 178 patients were enrolled from August 2014 to February 2015 with an equal distribution between arms as shown in the CONSORT diagram in Figure 1. Air leaks are a common yet critical problem that require quick diagnosis. For example, Braz et al. In the later years, however, they can administer anesthesia either independently or under remote supervision. As newer manufacturing techniques have decreased the occurrence of ETT defects, routine assessments of the ETT cuff integrity prior to use have become increasingly less common among providers. All data were double entered into EpiData version 3.1 software (The EpiData Association, Odense, Denmark), with range, consistency, and validation checks embedded to aid data cleaning. Terms and Conditions, The complaints sought in this study included sore throat, dysphagia, dysphonia, and cough. None of these was met at interim analysis. Anesthesia continued without further adjustment of ETT cuff pressure until the end of the case. Out of these cookies, the cookies that are categorized as necessary are stored on your browser as they are essential for the working of basic functionalities of the website. 22, no. Independent anesthesia groups at the three participating hospitals provided anesthesia to the participating patients. The cookie is created when the JavaScript library executes and there are no existing __utma cookies. We offer in-person, hands-on training at our Asheville, N.C., Spay/Neuter Training Cent Show more. Adequacy of cuff inflation is conventionally determined by palpation of the external balloon. Sanada Y, Kojima Y, Fonkalsrud EW: Injury of cilia induced by tracheal tube cuffs. Mandoe H, Nikolajsen L, Lintrup U, Jepsen D, Molgaard J: Sore throat after endotracheal intubation. B) Defective cuff with 10 ml air instilled into cuff. AW contributed to protocol development, patient recruitment, and manuscript preparation. An initial intracuff pressure of 30 cmH2O decreased to 20 cmH2O at 7 to 9 hours after inflation. R. J. Hoffman, V. Parwani, and I. H. Hahn, Experienced emergency medicine physicians cannot safely inflate or estimate endotracheal tube cuff pressure using standard techniques, American Journal of Emergency Medicine, vol. 1720, 2012. All these symptoms were of a new onset following extubation. This result suggests that clinicians are now making reasonable efforts to avoid grossly excessive cuff inflation. chin anteriorly), no lateral deviation, Open mouth and inspect: remove any dentures/debris, suction any secretions, Holding laryngoscope in left hand, insert it looking down its length, Slide down right side of mouth until the tonsils are seen, Now move it to the left to push the tongue centrally until the uvula is seen, Advance over the base of the tongue until the epiglottis is seen, Apply traction to the long axis of the laryngoscope handle (this lifts the epiglottis so that the V-shaped glottis can be seen), Insert the tube in the groove of the laryngoscope so that the cuff passes the vocal cords, Remove laryngoscope and inflate the cuff of the tube with 15ml air from a 20ml syringe, Attach ventilation bag/machine and ventilate (~10 breaths/min) with high concentration oxygen and observe chest expansion and auscultate to confirm correct positioning, Consider applying CO2 detector or end-tidal CO2 monitor to confirm placement, if it takes more than 30 seconds, remove all equipment and ventilate patient with a bag and mask until ready to retry intubation. Dont Forget the Routine Endotracheal Tube Cuff Check! The cookies collect this data and are reported anonymously. The allocation sequence was generated by an Internet-based application with the following input: nine sets of unsorted sequences, each containing twenty unique allocation numbers (120). stroke. The overall trend suggests an increase in the incidence of postextubation airway complaints in patients whose cuff pressures were corrected to 3140cmH2O compared with those corrected to 2030cmH2O. Endotracheal tube cuff pressure in three hospitals, and the volume required to produce an appropriate cuff pressure. Endotracheal tube cuff pressure in three hospitals, and the volume required to produce an appropriate cuff pressure, http://www.biomedcentral.com/1471-2253/4/8/prepub. We enrolled adult patients scheduled to undergo general anesthesia for elective surgery at Mulago Hospital, Uganda. Endotracheal tube system and method . One study, for instance, found that cuff pressure exceeded 40 cm H2O in 40-to-90% of tested patients [22]. CAS This is used to present users with ads that are relevant to them according to the user profile. 1993, 76: 1083-1090. Abstract: An endotracheal tube includes a main tubular portion including a distal end and a proximal end opposite the distal end, the main tubular portion including a central lumen at least in part defined by a wall of the main tubular portion; a . Cuff pressure in endotracheal (ET) tubes should be in the range of 2030 cm H2O. When this point was reached, the 10ml syringe was then detached from the pilot balloon, and a cuff manometer (VBM, Medicintechnik Germany. Inject 0.5 cc of air at a time until air cannot be felt or heard escaping from the nose or mouth (usually 5 to 8 cc). 345, pp. Because cuff inflation practices are likely to differ among clinical environments, we evaluated cuff pressure in three different practice settings: an academic university hospital and two private hospitals. 2003, 29: 1849-1853. 1990, 18: 1423-1426. Distractions in the Operating Room: An Anesthesia Professionals Liability? Martinez-Taboada F. The effect of user experience and inflation technique on endotracheal tube cuff pressure using a feline airway simulator. 28, no. This website uses cookies to improve your experience while you navigate through the website. The study was approved by Makerere University College of Health Sciences, School of Medicine Research Ethics Committee (SOMREC), The Secretariat Makerere University College of Health Sciences, Clinical Research Building, Research Co-ordination Office, P.O. This cookie is set by Stripe payment gateway. Generally, the proportion of ETT cuffs inflated to the recommended pressure was less in the PBP group at 22.5% (20/89) compared with the LOR group at 66.3% (59/89) with a statistically significant positive mean difference of 0.47 with value<0.01 (0.3430.602). American Society of Anesthesiology, Committee of Origin: Committee on Quality Management and Departmental Administration (QMDA). Notes tube markers at front teeth, secures tube, and places oral airway. 71, no. Therefore, anesthesia providers commonly rely on subjective methods to estimate safe endotracheal cuff pressure. This cookie is used by the WPForms WordPress plugin. The high incidence of postextubation airway complaints in this study is most likely a site-specific problem but one that other resource-limited settings might identify with. Inflate the cuff of the endotracheal tube with sufficient air to seal the area between the trachea and the tube. El-Orbany M, Salem MR. Endotracheal tube cuff leaks: causes, consequences, and management. Our results are consistent in that measured cuff pressure exceeded 30 cmH2O in 50% of patients and were less than 20 cmH2O in 23% of patients. The cookie is updated every time data is sent to Google Analytics. The secondary objective of the study evaluated airway complaints in those who had cuff pressure in the optimal range (2030cmH2O) and those above the range (3140cmH2O). The pressures measured were recorded. In the absence of clear guidelines, many clinicians consider 20 cm H2O a reasonable lower limit for cuff pressure in adults. The study was approved by the School of Medicine Research and Ethics Committee, Makerere University, and registered with http://www.clinicaltrials.gov (NCT02294422). Endotracheal intubation is done to: Keep the airway open in order to give oxygen, medicine, or anesthesia. Cuff pressures were thus less likely to be within the recommended range (2030 cmH2O) than outside the range. Anesth Analg. The mean volume of inflated air required to achieve an intracuff pressure of 25 cmH2O was 7.1 ml. Br Med J (Clin Res Ed). 154, no. Taking another approach to the same question, we also determined compliance of the cuff-trachea system in vivo by plotting measured cuff pressure against cuff volume. How much air is injected into the cuff is not a major concern for almost all anaesthetists and they usually depend on palpating the external cuff tense to judge is it too much, accurate or not enough? The chi-square test was used for categorical data. Also, at the end of the pressure measurement in both groups, the manometer was detached, breathing circuit was attached to the ETT, and ventilation was started. This category only includes cookies that ensures basic functionalities and security features of the website. Consecutive available patients were enrolled until we had recruited at least 10 patients for each endotracheal tube size at each participating hospital. Christina M. Brown, MD, Resident, Department of Anesthesiology, Washington University in St. Louis, MO. S. W. Wangaka, Estimation of endotracheal tube cuff pressures at Kenyatta National Hospital, University of Nairobi, Nairobi, Kenya, 2006. The cookie is set by CloudFare. 1985, 87: 720-725. The author(s) declare that they have no competing interests. Considering that this was a secondary outcome, it is possible that the sample size was small, hence leading to underestimation of the incidence of postextubation airway complaints between the groups. These included an intravenous induction agent, an opioid, and a muscle relaxant. 795800, 2010. Aire cuffs are "mid-range" high volume, low pressure cuffs. M. H. Bennett, P. R. Isert, and R. G. Cumming, Postoperative sore throat and hoarseness following tracheal intubation using air or saline to inflate the cuffa randomized controlled trial, Anesthesia and Analgesia, vol. The cookie is set by the GDPR Cookie Consent plugin and is used to store whether or not user has consented to the use of cookies. 5, pp. 18, no. Interestingly, the amount of air required to achieve a cuff pressure of 20 cmH2O was similar with each tube size (Table 3). The cookie is updated every time data is sent to Google Analytics. All patients with any of the following conditions were excluded: known or anticipated laryngeal tracheal abnormalities or airway trauma, preexisting airway symptoms, laparoscopic and maxillofacial surgery patients, and those expected to remain intubated beyond the operative room period. Acta Anaesthesiol Scand. Volume+2.7, r2 = 0.39 (Fig. 1.36 cmH2O. Advertisement cookies help us provide our visitors with relevant ads and marketing campaigns. Cuff pressure adjustment: in both arms, very high and very low pressures were adjusted as per the recommendation by the ethics committee. 3, p. 172, 2011. You also have the option to opt-out of these cookies. Secures tube using commercially approved tube holder. We use cookies on our website to give you the most relevant experience by remembering your preferences and repeat visits. This cookie is installed by Google Analytics. If pressure remains > 30 cm H2O, Evaluate . Measured cuff volume averaged 4.4 1.8 ml. Cuff pressure is essential in endotracheal tube management. The patient was the only person blinded to the intervention group. However, complications have been associated with insufficient cuff inflation. Cuff pressure adjustment: in both arms, very high and very low pressures were adjusted as per the recommendation by the ethics committee. What are the . We tested the hypothesis that the tube cuff is inadequately inflated when manometers are not used. A syringe is inserted into the valve and depressed until a suitable intracuff pressure is reached. The cookie is used to allow the paid version of the plugin to connect entries by the same user and is used for some additional features like the Form Abandonment addon. Gac Med Mex. These data suggest that management of cuff pressure was similar in these two disparate settings. The patients were followed up and interviewed only once at 24 hours after intubation for presence of cough, sore throat, dysphagia, and/or dysphonia. Nitrous oxide was disallowed. Pelc P, Prigogine T, Bisschop P, Jortay A: Tracheoesophageal fistula: case report and review of literature. T. M. Cook, N. Woodall, and C. Frerk, Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. The poster can be accessed by following the link: https://pdfs.semanticscholar.org/c12e/50b557dd519bbf80bd9fc60fb9fa2474ce27.pdf. Evrard C, Pelouze GA, Quesnel J: [Iatrogenic tracheal and left bronchial stenoses. An anesthesia provider inserted the endotracheal tubes, and the intubator or the circulating registered nurse inflated the cuff. 1mmHg equals how much cmH2O? Lomholt et al. This has been shown to cause severe tracheal lesions and morbidity [7, 8]. The cuff was then progressively inflated by injecting air in 0.5-ml increments until a cuff pressure of 20 cmH2O was achieved. This cookie is set by Google analytics and is used to store the traffic source or campaign through which the visitor reached your site. We appreciate the assistance of Diane Delong, R.N., B.S.N., Ozan Aka, M.D., and Rainer Lenhardt, M.D., (University of Louisville). The total number of patients who experienced at least one postextubation airway symptom was 113, accounting for 63.5% of all patients. After screening, participants were allocated to either the PBP or the LOR group using block randomization, achieving a 1:1 allocation ratio. The cookie is set by Google Analytics and is deleted when the user closes the browser. Reduces risk of creasing on inflation and minimises pressure on tracheal wall. Informed consent was sought from all participants. If the tracheal lumen is in the appropriate position (i.e., it has not been placed too deeply), bilateral breath sounds will. Alternatively, cheaper, reproducible methods, like the minimum leak test that limit overly high cuff pressures should be sought and evaluated. Alternative, cheaper methods like the minimum leak test that require no special equipment have produced inconsistent results. There was a linear relationship between measured cuff pressure (cmH2O) and volume (ml) of air removed from the cuff: Pressure = 7.5. Decrease the cuff pressure to 30 cm H2O by withdrawing a small amount of air from the balloon with a 10 mL syringe. None of the authors have conflicts of interest relating to the publication of this paper. The groups were not equal for the three different types of practitioners; however, determining differences of practice between different anesthesia providers was not the primary purpose of our study. 8184, 2015. There was no correlation between the measured cuff pressure and the age, sex, height, or weight of the patients. By using this website, you agree to our This was statistically significant. The data collected including the number visitors, the source where they have come from, and the pages visited in an anonymous form. The rate of optimum endotracheal tube cuff pressure was 90.5% in the group guided by manometer and 31.8% in the conventional procedure group (p < 0.001 . 3 2016 National Geriatric Surgical Initiatives, 2017 EC Pierce Lecture: Safety Beyond Our Borders, The Anesthesia Professionals Role in Patient Safety During TAVR (Transcatheter Aortic Valve Replacement). J. Liu, X. Zhang, W. Gong et al., Correlations between controlled endotracheal tube cuff pressure and postprocedural complications: a multicenter study, Anesthesia and Analgesia, vol.
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