PNEUMOPERITONEUM AS A RISK FACTOR FOR ENDOBRONCHIAL INTUBATION DURINGLAPAROSCOPIC GYNECOLOGIC SURGERY

Patients undergoing gynecological surgery under laparoscopic guidance usually receive general anesthesia with endotracheal intubation and me chanical ventilation. The creation of a pneumoperitoneum and the Trend elenburg position, both of which are used to improve visualization, ar e associated with cephalad movement of the diaphragm. This may increas e the risk of endobronchial intubation. We studied the change in the d istance from the tip of the endotracheal tube (ETT) to the carina with a fiberoptic bronchoscope in 30 patients aged 21-40 yr who were under going laparoscopic tubal ligation (n = 28) or hysterectomy (n = 2). Me asurements were taken in the supine and Trendelenburg positions before and after pneumoperitoneum. The average distance from the ETT to the carina in the supine position was 2.1 +/- 0.8 cm and in the Trendelenb urg position was 1.8 +/- 0.8 cm (P = not significant). After insufflat ion of the abdominal cavity, the mean distance decreased to 0.7 +/- 1. 4 cm in the supine position (P < 0.05) and was associated with endobro nchial intubation in eight patients. The addition of the Trendelenburg position to an established pneumoperitoneum resulted in minimal displ acement (0.54 +/- 1.4 cm, P < 0.05) and one additional endobronchial i ntubation. We conclude that the insufflation of gas in the abdominal c avity, and not the change in patient position, is the main risk factor for endobronchial intubation in patients undergoing laparoscopic gyne cologic surgery. Implications: This study demonstrated that in anesthe tized women, the insufflation of gas into the abdomen during laparosco py for gynecologic surgery is the main risk factor for migration of th e endotracheal tube into a bronchus.