Canada: over-pressurized

  • Fabio MagistrisEmail author
  • Stefan Kojic
  • Jennifer O’Brien
  • Jonathan Gamble

To the Editor,

In reference to the article published by Miao et al.,1 we would like to provide further insight into the practices of cuff pressure manometry in the context of the Canadian Anesthesiologists’ Society (CAS) guidelines.2 Miao demonstrated that 33/113 (29%) of endotracheal tube (ETT) cuffs and 8/14 (57%) of supraglottic airway (SGA) cuffs exceeded the recommended maximum pressures of 30 cmH2O and 60 cmH2O, respectively.3,4 Palpation of the pilot balloon was reported as the most common method to determine appropriate ETT cuff pressure. Fifty of 66 respondents (76%) reported using cuff manometry less than once per month.

We conducted a two-part study: 1) a prospective evaluation of intraoperative ETT and SGA cuff pressures at four Saskatchewan hospitals, and 2) a Canada-wide survey of anesthesiologists’ airway cuff management practices (see eAppendix, available as Electronic Supplementary Material). Research ethics board approval for both projects was obtained from the Regina...



The researchers gratefully acknowledge the assistance of the Saskatoon Health Region and the Regina Qu’Appelle Health Region. We also acknowledge the support of Dr. David Campbell and Dr. Theo LeRoux as the anesthesiology department heads in Saskatoon and Regina.

Conflict of interest

Commercial or non-commercial affiliations that are or may be perceived to be a conflict of interest with the work for each author; and any other associations, such as consultancies: No author has any commercial or other affiliations that are, or may be perceived to be, a conflict of interest.

Editorial responsibility

This submission was handled by Dr. Gregory L. Bryson, Deputy Editor-in-Chief, Canadian Journal of Anesthesia.

Funding sources

Funding provided by the Department of Anesthesiology, Perioperative Medicine and Pain Management at the University of Saskatchewan for survey distribution to Canadian Anesthesiologists’ Society members.

Supplementary material

12630_2018_1236_MOESM1_ESM.pdf (176 kb)
Supplementary material 1 (PDF 176 kb)


  1. 1.
    Miao I, Jee R, Pysyk CL. Under pressure: an audit of airway device pressures. Can J Anesth 2018; 65: 726-7.CrossRefGoogle Scholar
  2. 2.
    Dobson G, Chong M, Chow L, et al. Guidelines to the Practice of Anesthesia - Revised Edition 2018. Can J Anesth 2018; 65: 76-104.Google Scholar
  3. 3.
    Seegobin RD, van Hasselt GL. Endotracheal cuff pressure and tracheal mucosal blood flow: endoscopic study of effects of four large volume cuffs. Br Med J (Clin Res Ed) 1984; 288: 965-8.CrossRefGoogle Scholar
  4. 4.
    Seet E, Yousaf F, Gupta S, Subramanyam R, Wong DT, Chung F. Use of manometry for laryngeal mask airway reduces postoperative pharyngolaryngeal adverse events: a prospective, randomized trial. Anesthesiology 2010; 112: 652-7.CrossRefGoogle Scholar
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    Sultan P, Carvalho B, Rose BO, Cregg R. Endotracheal tube cuff pressure monitoring: a review of the evidence. J Perioper Pract 2011; 21: 379-86.CrossRefGoogle Scholar

Copyright information

© Canadian Anesthesiologists' Society 2018

Authors and Affiliations

  1. 1.Department of Anesthesiology, Perioperative Medicine and Pain ManagementUniversity of Saskatchewan, Royal University HospitalSaskatoonCanada

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