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GENERAL ARTICLES

The Endotracheal Tube Moves More Often in Obese Patients Undergoing Laparoscopy Compared with Open Abdominal Surgery

Tiberiu Ezri, MD^*, Vadim Hazin, MD^*, David Warters, MD, Peter Szmuk, MD, and Avi A. Weinbroum, MD

*Department of Anesthesiology, Wolfson Medical Center, Holon, Israel; Sackler Faculty of Medicine, Tel Aviv, Israel; The University of Texas Medical School, Houston, Texas; and Department of Anesthesiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel

Address correspondence and reprint requests to Avi A. Weinbroum, MD, Post Anesthesia Care Unit, Tel Aviv Sourasky Medical Center, 6 Weizman St., Tel Aviv 64239, Israel. Address e-mail to draviw{at}tasmc.health.gov.il

We compared the incidence of movements of the endotracheal tube (ETT) within the trachea in morbidly obese patients undergoing either laparoscopic or open gastroplasty. In a double-blinded, prospective, controlled study, 60 patients (body mass index, 35–60 kg/m²) were equally allocated to either laparoscopic LapBand gastroplasty (study group; Group 1) or open laparotomy gastroplasty (control; Group 2), both under standardized general anesthesia. Movements of the ETT were assessed with chest auscultation, peak inspiratory pressure, ETCO₂, SpO₂, and the Rapiscope^TM at predetermined time points: after intubation (baseline values), 5 min before peritoneal inflation in Group 1 and 10 min postintubation in Group 2, at maximal abdominal inflation in Group 1 and 20 min into the procedure in Group 2, 5 min before and 5 min after changing the patient’s position from neutral to 10° head up and 10° head down in Group 1 and 30 and 40 min into the procedure in Group 2, 2 min after abdominal deflation and table repositioning in Group 1 and at 50 min in Group 2, and just before extubation in both groups. Twenty-one events of ETT tip movement occurred in both groups. The tube moved in 15 (50%) study (laparoscopy) group patients compared with 6 (20%) controls (laparotomy; P < 0.05), 12 of the former having moved downward either after maximal abdominal insufflation or in association with head-down positioning. The tubes of five study group patients (17%) advanced into the right bronchus, compared with none in the controls (P < 0.05). All changes in position were rectified only by the Rapiscope^TM.

IMPLICATIONS: Abdominal insufflation and changes in table position lead to more frequent movements of the endotracheal tube in obese patients undergoing laparoscopic versus open gastroplasty. The Rapiscope^TM identifies all these changes, but not the clinically available variables.