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Journal of Robotic Surgery

, Volume 13, Issue 3, pp 463–468 | Cite as

Changes in airway dimensions after robot assisted surgeries in steep Trendelenburg position

  • Seran Reddy
  • Divya JainEmail author
  • Kajal Jain
  • Komal Gandhi
  • Ravi Mohan
  • Mandeep Kang
Original Article

Abstract

Robotic surgeries in the extreme Trendelenburg position can lead to changes in the airway dimensions. We conducted a prospective, observational trial to explore the use of ultrasound to quantify these changes in the airway dimensions and identify the factors associated with it. Fifty-two American society of Anaesthesiologists physical status I–II patients between 18 and 70 years of age of either sex scheduled to undergo robot assisted urological procedures in steep Trendelenburg position were enrolled. Anterior soft tissue thickness at the level of hyoid bone and vocal cords, tongue thickness, Malampatti grading and neck circumference were measured at predefined postoperative intervals in the immediate postoperative period, at 2-, 6- and 12-h period postoperatively. Linear stepwise regression analysis was done to explore the factors associated with change in anterior tissue thickness immediately after surgery. The mean difference (95%; CI) in the anterior soft tissue thickness in the immediate postoperative period at the level of hyoid was 0.023 (0.029–0.016) cm, p < 0.001 and at level of vocal cords was − 0.012 (− 0.017 to − 0.008) cm, p < 0.001 from the baseline. There was a significant increase in tongue thickness (0.002), Mallampati score (p = 0.002) and neck circumference (p < 0.001) in immediate postoperative period. The change in anterior tissue thickness at the level of hyoid was affected by total intraoperative fluids used (r = 0.602, p < 0.001), airway trauma (r = 0.275, p = 0.002) and duration of surgery (r = 0.243, p = 0.025). Significant changes in airway dimensions after robotic surgeries in Trendelenburg position persist till 2 h in the postoperative period which warrant vigilant monitoring for any airway compromise during this period.

Keywords

Airway assessment Ultrasonography Upper airway anatomy Head down position. 

Notes

Funding

None.

Compliance with ethical standards

Conflict of interest

Author Seran Reddy, Author Divya Jain, Author Kajal Jain, Author Komal Gandhi, Author Ravi Mohan, Author Mandeep Kang declare that they have no conflict of interest.

References

  1. 1.
    Hoshikawa Y, Tsutsumi N, Ohkoshi K et al (2014) The effect of steep Trendelenburg positioning on intraocular pressure and visual function during robotic-assisted radical prostatectomy. Br J Ophthalmol 98:305–308CrossRefGoogle Scholar
  2. 2.
    Hamdy Awad H, Santilli S, Ohr M et al (2009) The effects of steep Trendelenburg positioning on intraocular pressure during robotic radical prostatectomy. Anesth Analg 109:473–478CrossRefGoogle Scholar
  3. 3.
    Martínez-Salamanca JI, Romero Otero J (2007) Critical comparative analysis between open, laparoscopic and robotic radical prostatectomy: perioperative morbidity and oncological results (Part I). Arch Esp Urol 60:755–765Google Scholar
  4. 4.
    Phong SV, Koh LK (2007) Anaesthesia for robotic-assisted radical prostatectomy: considerations for laparoscopy in the Trendelenburg position. Anaesth Intensive Care 35:281–285CrossRefGoogle Scholar
  5. 5.
    Goswami S, Nishanian E, Mets B (2010) Anesthesia for robotic surgery. In: Miller RD (ed) Miller’s anesthesia, 7th edn. Elsevier, Philadelphia, pp 2289–2395Google Scholar
  6. 6.
    Cook TM, Woodall N, Harper J, Benger J (2011) Fourth national audit project. 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. Part 2: Intensive care and emergency departments. Br J Anaesth 106:632–642CrossRefGoogle Scholar
  7. 7.
    Ezri T, Gewurtz G, Sessler DI et al (2003) Prediction of difficult laryngoscopy in obese patients by ultrasound quantification of anterior neck soft tissue. Anaesthesia 58:1111–1114CrossRefGoogle Scholar
  8. 8.
    Singh M, Chin KJ, Chan VWS, Wong DT, Prasad GA, Yu E (2010) Use of sonography for airway assessment. J Ultrasound Med 29:79–85CrossRefGoogle Scholar
  9. 9.
    Adhikari S, Zeger W, Schmier C et al (2011) Pilot study to determine the utility of point-of-care ultrasound in the assessment of difficult laryngoscopy. Acad Emerg Med 18:754–758CrossRefGoogle Scholar
  10. 10.
    Wijeysundera DN, Sweitzer B (2015) Preoperative evaluation. In: Miller RD Miller’s anesthesia, 1092, 8th edn. Elsevier, CanadaGoogle Scholar
  11. 11.
    Hauch MA, Datta S, Segal BS (1995) Maternal and fetal colloid osmotic pressure following fluid expansion during cesarean section. Crit Care Med 23:510–514CrossRefGoogle Scholar
  12. 12.
    Lestar M, Gunnarsson L, Lagerstrand L, Wiklund P et al (2011) Hemodynamic perturbations during robot assisted laparoscopic radical prostatectomy in Trendelenburg position. Anesth Analg 113:1069–1075CrossRefGoogle Scholar
  13. 13.
    Rewari V, Ramachandran R (2013) Prolonged steep Trendelenburg position: risk of postoperative upper airway obstruction. J Robot Surg 7:405–406CrossRefGoogle Scholar
  14. 14.
    Menekse O, Ziya A, Hakan O et al (2014) Anesthetic considerations for robotic cystectomy: a prospective study. Rev Bras Anestesiol 64:109–115CrossRefGoogle Scholar
  15. 15.
    Kilic OF, Börgers A, Köhne W et al (2015) Effects of steep Trendelenburg position for robotic-assisted prostatectomies on intra- and extrathoracic airways in patients with or without chronic obstructive pulmonary disease. Br J Anaesth 114:70–76CrossRefGoogle Scholar
  16. 16.
    Komatsu R, Sengupta P, Wadhwa A et al (2007) Ultrasound quantification of anterior soft tissue thickness fails to predict difficult laryngoscopy in obese patients. Anaesth Intensive Care 35:32–37CrossRefGoogle Scholar
  17. 17.
    Ushiroda J, Inoue S, Kirita T, Kawaguchi M (2014) A comparison of airway dimensions, measured by acoustic reflectometry and ultrasound before and after general anaesthesia. Anaesthesia 69:1355–1363CrossRefGoogle Scholar
  18. 18.
    Wilson ME, John R (1990) Problems with the Mallampati sign. Anaesthesia 45:486–487CrossRefGoogle Scholar
  19. 19.
    Bair AE, Caravelli R, Tyler K, Laurin EG (2010) Feasibility of the preoperative Mallampati airway assessement in emergency department patients. J Emerg Med 38:677–680CrossRefGoogle Scholar

Copyright information

© Springer-Verlag London Ltd., part of Springer Nature 2018

Authors and Affiliations

  • Seran Reddy
    • 1
  • Divya Jain
    • 1
    Email author
  • Kajal Jain
    • 1
  • Komal Gandhi
    • 1
  • Ravi Mohan
    • 2
  • Mandeep Kang
    • 3
  1. 1.Department of Anesthesia and Intensive CarePostgraduate Institute of Medical Education and Research (PGIMER)ChandigarhIndia
  2. 2.Department of UrologyPGIMERChandigarhIndia
  3. 3.Department of RadiodiagnosisPGIMERChandigarhIndia

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