Movement of the endotracheal tube during laparoscopic hernia repair

Background: Laparoscopic surgery is not without its problems, and one of th e less known is cephalad displacement of the carina and relative movement o f the endotracheal tube in the trachea. The aetiology of this is presumably a consequence of both pneumoperitoneum and the Trendelenburg position freq uently adopted during laparoscopic surgery. Method: We studied 30 patients undergoing laparoscopic hernia repair utilis ing 10 degrees of Trendelenburg position and an intra-abdominal inflation p ressure of between 12 and 15 mm Hg (mean 13.6 mm Hg). We measured the dista nce between the tip of the endotracheal tube and the carina using a fibreop tic bronchoscope. Result: This 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 ti lt and pneumoperitoneum. This did not represent a statistically significant change (P=0.09). Conclusion: We conclude that the endotracheal tube does not routinely migra te towards the carina when laparoscopic hernia repair is performed under th ese conditions. (C) Acta Anaesthesiologica Scandinavica 44 (2000).