Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India.
Department of Urology, PGIMER, Chandigarh, India.
J Robot Surg. 2019 Jun;13(3):463-468. doi: 10.1007/s11701-018-0869-3. Epub 2018 Aug 31.
Robotic surgeries in the extreme Trendelenburg position can lead to changes in the airway dimensions. We conducted a prospective, observational trial to explore the use of ultrasound to quantify these changes in the airway dimensions and identify the factors associated with it. Fifty-two American society of Anaesthesiologists physical status I-II patients between 18 and 70 years of age of either sex scheduled to undergo robot assisted urological procedures in steep Trendelenburg position were enrolled. Anterior soft tissue thickness at the level of hyoid bone and vocal cords, tongue thickness, Malampatti grading and neck circumference were measured at predefined postoperative intervals in the immediate postoperative period, at 2-, 6- and 12-h period postoperatively. Linear stepwise regression analysis was done to explore the factors associated with change in anterior tissue thickness immediately after surgery. The mean difference (95%; CI) in the anterior soft tissue thickness in the immediate postoperative period at the level of hyoid was 0.023 (0.029-0.016) cm, p < 0.001 and at level of vocal cords was - 0.012 (- 0.017 to - 0.008) cm, p < 0.001 from the baseline. There was a significant increase in tongue thickness (0.002), Mallampati score (p = 0.002) and neck circumference (p < 0.001) in immediate postoperative period. The change in anterior tissue thickness at the level of hyoid was affected by total intraoperative fluids used (r = 0.602, p < 0.001), airway trauma (r = 0.275, p = 0.002) and duration of surgery (r = 0.243, p = 0.025). Significant changes in airway dimensions after robotic surgeries in Trendelenburg position persist till 2 h in the postoperative period which warrant vigilant monitoring for any airway compromise during this period.
机器人手术在极端头高脚低位可导致气道尺寸的变化。我们进行了一项前瞻性、观察性试验，旨在探讨使用超声来量化气道尺寸的这些变化，并确定与之相关的因素。纳入 52 例美国麻醉医师协会身体状况 I-II 级、18 至 70 岁、男女不限的患者，计划在头高脚低位行机器人辅助泌尿科手术。在术后即刻、术后 2、6 和 12 小时，测量舌骨水平和声带水平的前软组织厚度、舌厚度、马兰帕蒂分级和颈围。线性逐步回归分析用于探讨与术后即刻前组织厚度变化相关的因素。术后即刻舌骨水平前软组织厚度的平均差值（95%CI）为 0.023（0.029-0.016）cm，p<0.001，声带水平为-0.012（-0.017 至-0.008）cm，p<0.001。与基线相比，术后即刻舌厚度（0.002）、马兰帕蒂评分（p=0.002）和颈围（p<0.001）均显著增加。术后即刻前组织厚度的变化受总术中液体用量（r=0.602，p<0.001）、气道创伤（r=0.275，p=0.002）和手术时间（r=0.243，p=0.025）的影响。在头高脚低位机器人手术后，气道尺寸的显著变化持续到术后 2 小时，在此期间需要警惕任何气道阻塞。
