CHANGES IN TRACHEAL TUBE POSITION DURING LAPAROSCOPIC CHOLECYSTECTOMY

The distance from the carina to the tip of the tracheal tube was measu red with a fibreoptic bronchoscope in 21 consecutive patients undergoi ng elective laparoscopic cholecystectomy. After placement of an Eschma nn tracheal tube with a printed intubation guide mark at the vocal cor ds, the distance was 28 (15) [5-54]mm (mean (SD) [range]). The tube wa s then repositioned so that the distance was 34 (3) [30-40]mm from tip of the tube to the carina. After creation of pneumoperitoneum, the di stance was significantly decreased to 26 (5) [17-35]mm (p < 0.005), wh ich was not significantly altered by subsequent moving of the patient to the reverse Trendelenburg and left lateral tilt position. The maxim um distance of tube migration was 8 (4) [0-15]mm. Four out of 21 patie nts would have been at risk of bronchial intubation after pneumoperito neum if the tube had not been repositioned. Placement of the tube acco rding to the guide mark is not recommended for laparoscopic cholecyste ctomy.