The use of cuffed endotracheal tubes in infants and small children

The use of endotracheal tubes with a cuff is controversial in infants and s mall children. Often anaesthetists advocate extreme opinions and whereas so me propagate the use of cuffed tubes in all cases without restriction, othe rs condemn their use in infants and small children under all circumstances. In this article,the discussion concerning the use of cuffed endotracheal t ubes in infants and small children is based on current data and arguments. Relevant facts about the anatomy of the upper airway are reviewed and tube products that are currently available, their correct use in infants as well as the inherent potential advantages and disadvantages related to their us e are discussed. The overall incidence of iatrogenic damage after short las ting endotracheal intubation is low. However, acquired subglottic stenosis might represent a severe longlasting complication. Regardless as to whether tubes with or without cuffs are used, a disproportion between the outer di ameter of the tube and the inner diameter of the nonexpandable cricoid ring is the main reason for the genesis of this lesion. A continuous monitoring of the cuff pressure is recommended when using cuffed endotracheal tubes i n this age group.