• Nishkarsh Gupta, K K Girdhar, Anil Misra, Raktima Anand, Akhil Kumar, and Gunjan.
• Attending Consultant Anaesthesia, Max Saket, Delhi, India.
• J Anaesthesiol Clin Pharmacol. 2010 Oct 1;26(4):537-8.

BackgroundThe positioning (trendelenburg) and pneumoperitoneum during laparoscopic gynecological surgeries may cause cephalad movement of diaphragm and subsequent endobronchial intubation. PATIENTS #ENTITYSTARTX00026;Methods50 ASA I/II patients posted for laparoscopic ligation were included in the study. Standardized anaesthesia technique was employed in all the patients. The distance of endotracheal tube to carina was measured in supine position, trendelenberg position, 5 min and 25 minutes post pneumoperitoneum and after deflation of pneumo-peritoneum.ResultsThe mean distance from the tip of the ETT to the carina was 3.41± 1.3 cm, 2.96 ± 1.4, 2.0 ± 1.5 and 1.7 ± 1.6 in supine position, trendelenburg position and 5min and 25 min post pneumoperitoneum. (P<0.01) Following deflation the carina moved back to its position to some extent and was 2.5 ± 1.5 from the tip of endotracheal tube.( P< 0.05)ConclusionWe conclude that pneumoperitoneum and trendelenburg position during laparoscopic surgeries may lead to cephalad migration of carina.

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