Background and Aims: In robotic and laparoscopic oncological surgeries, a combination of pneumoperitoneum and Trendelenburg position causes a cephalad displacement of the diaphragm, increasing the chances of endobronchial migration of the endotracheal tube. The study aimed to identify the endotracheal tube displacement in Trendelenburg position in robotic and laparoscopic oncological surgeries and identify the factors responsible for it. Methods: After Institutional Ethics Committee approval, a prospective, observational study was conducted from June 2019 to March 2020. Fifty patients undergoing robotic and laparoscopic oncological surgeries requiring Trendelenburg position were recruited. A flexible fibre-optic bronchoscope was used to measure the distance between the tracheal tube tip and the carina at the following time points –10 min after induction, 10 min after insufflation, 10 min after Trendelenburg and 30 min after Trendelenburg position. Tube fixation at the lips, degree of Trendelenburg tilt, intra-abdominal pressure, positive end-expiratory pressure (PEEP) and desaturation episode were recorded. The mean endotracheal tube tip-to-carina distances at the four time points were compared using the paired t-test. P < 0.05 was considered to be statistically significant. Results: We found a significant reduction in the distance between the tracheal tube tip and the carina post-insufflation and Trendelenburg position (P < 0.05) with a tilt >25°. Conclusion: Endobronchial migration of the endotracheal tube is more likely when the tracheal tube tip to the carinal distance is <3 cm. Hence, confirming that the tracheal tube tip is positioned more than 3 cm above the carina with a flexible fibre-optic bronchoscopy would be wise for patients undergoing robotic and laparoscopic oncological surgeries.
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