Efficacy of the three-point cuff palpation technique in preventing endobronchial tube migration during positioning in robotic pelvic surgeries

Abstract

Background and Aims: During robotic pelvic surgeries, the shortening of endotracheal tube (ETT) tip-to-carina distance (D TC ) during pneumoperitoneum with 45° Trendelenburg position can result in endobronchial tube migration. In the three-point ETT cuff palpation (TPP) technique, maximal ETT cuff distension is felt over the tracheal segment located between the cricoid-thyroid membrane and suprasternal notch, which is likely to provide optimal placement. However, the reproducibility and reliability of the TPP technique in preventing endobronchial tube migration are yet to be evaluated. Hence, we compared three ETT placement techniques: TPP technique, intubation guide mark (IGM) technique and Varshney’s formula (VF) for the prevention of endobronchial tube migration during robotic pelvic surgeries. Methods: ETT placement by TPP was compared with IGM and VF techniques in 100 American Society of Anesthesiologists physical class II-III patients, by assessing the serial changes in D TC and incidence of endobronchial tube migration throughout the different phases of pneumoperitoneum and Trendelenburg position using t-test and Chi-square test. Changes in the D TC during various phases were also measured. Results: D TC (mean ± standard deviation) at baseline and during pneumoperitoneum was significantly better in TPP technique (2.80 ± 0.62 cm and 1.96 ± 0.66 cm) as compared to both IGM (2.50 ± 1.27 cm and 1.41 ± 1.29 cm) and VF techniques (1.83 ± 1.13 cm and 0.98 ± 1.18 cm), P < 0.001. During pneumoperitoneum, the mean shortening of D TC was 0.84 ± 0.20 cm, and no endobronchial tube migration was found in TPP technique compared to 20% in IGM and 25% in VF techniques, P < 0.001. Conclusion: TPP is a simple and reliable technique, which provides optimal ETT placement and prevents endobronchial tube migration throughout the different phases of robotic pelvic surgeries.

Anesthetic Management of Robot-Assisted Laparoscopic Surgery of Pheochromocytoma

“…As part of the standard introduction to general anesthesia involves securing the airway by using the right-sized endotracheal tube (ET) tube, which should be properly inserted, and the position of the tube should be checked by auscultation, after which it should be properly taped and fixed, a high probability of the tube migrating into the unventilated lung and collapsing, causing hypoxia, is a possibility. A threepoint ET cuff palpation approach is easy to use, reliable, and successful in decreasing the chances of endobronchial tube movement during robotic pelvic surgery, according to a recently published study [9]. ET tube position should also be checked regularly.…”

Anaesthetic management of robot-assisted laparoscopic surgery

“…In a recently published study, the authors found that the three-point endotracheal tube cuff palpation technique is simple, reliable and effective in preventing endobronchial tube migration during robotic pelvic surgery. [ 14 ] Furthermore, tube placement should be checked frequently. Tidal volume should be maintained between 6 and 8 ml/kg with plateau pressure (P PLAT ) not exceeding 30 cm of H 2 O.…”