Pneumoperitoneum as a Risk Factor for Endobronchial Intubation During Laparoscopic Gynecologic Surgery

Abstract

This study demonstrated that in anesthetized women, the insufflation of gas into the abdomen during laparoscopy for gynecologic surgery is the main risk factor for migration of the endotracheal tube into a bronchus.

Use of the Rapiscope vs chest auscultation for detection of accidental bronchial intubation in non-obese patients undergoing laparoscopic cholecystectomy

“…As what happened with the 4 other cases of bronchial intubation, additional movement of the mediastinum might be caused by the abdominal gas inflation [7,11,12]. This may be further exaggerated in obese patients [3,13].…”

“…In this latter study, one third of the affected cases were associated with head or neck surgery and with possible flexion of the patient's head. Noteworthy, taping the endotracheal tube at a predetermined distance did not guarantee the avoidance of the tube migration or endobronchial intubation [11].…”

Changes in endotracheal tube cuff pressure during laparoscopic surgery in head-up or head-down position

“…There were reports indicating endotracheal shortening in the laparoscopic surgery with cephalad movement of the carina [18,19] and the conformational change of the trachea by abdominal insufflation and the gravitational effect of the head-down tilt may be the underlying mechanism behind the elevated cuff pressure. In the present study, an excessive cuff pressure during laparoscopic surgery was found not only in obese but also non-obese patients.…”

Proper insertion depth of endotracheal tubes in adults by topographic landmarks measurements

“…In patients with cardiac arrest intubated by advanced cardiac life support (ACLS) course-certified physicians, the incidence of bronchial intubation was 28% [10]. In addition, properly positioned ETTs might move later into one of the bronchi with a change of the patient's position [11], flexion or extension of the head [12], or peritoneal insufflation [11,13].…”