• C Mendonca, I Baguley, A J Kuipers, D King, and F Y Lam.
• Department of Anaesthesia, Royal Shrewsbury Hospital NHS Trust, United Kingdom.
• Acta Anaesthesiol Scand. 2000 May 1;44(5):517-9.

BackgroundLaparoscopic surgery is not without its problems, and one of the less known is cephalad displacement of the carina and relative movement of the endotracheal tube in the trachea. The aetiology of this is presumably a consequence of both pneumoperitoneum and the Trendelenburg position frequently adopted during laparoscopic surgery.MethodWe studied 30 patients undergoing laparoscopic hernia repair utilising 10 degrees of Trendelenburg position and an intra-abdominal inflation pressure of between 12 and 15 mm Hg (mean 13.6 mm Hg). We measured the distance between the tip of the endotracheal tube and the carina using a fibreoptic bronchoscope.ResultThis distance decreased only slightly, from a mean (SD) of 39.6 (13) mm after intubation, to 38.9 (12.6) mm after adoption of Trendelenburg tilt and pneumoperitoneum. This did not represent a statistically significant change (P=0.09).ConclusionWe conclude that the endotracheal tube does not routinely migrate towards the carina when laparoscopic hernia repair is performed under these conditions.

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