Prevention of Endotracheal Tube Migration by Cuff Palpation During Robotic Surgical Procedure

To Evaluate "Three Point Cuff Palpation Technique" for Assessing Optimal Depth of Endotracheal Tube Placement.

After intubation, the endotracheal tube was finally fixed after palpating endotracheal cuff at three sites (just below the cricoid cartilage, at suprasternal level and just below suprasternal notch). Fibre optic bronchoscopy will be done to find distance between tip of endotracheal tube and carina. This distance will be measured repeatedly, after pneumoperitoneum, after trendelenburg position and after making the patient supine at the end of surgery. Change in the distance will be noted.

The endotracheal tube (ETT) will be placed according to the black mark on the tube, post-intubation, the tube will be finally fixed after palpating endotracheal cuff at three sites (below cricoid cartilage, at suprasternal level and just below suprasternal notch). ETT cuff position will be scanned by sonography of airway to confirm the position of the proximal end of the ETT cuff. Fibre optic bronchoscopy will be done to find distance between tip of endotracheal tube and carina. This distance will be measured repeatedly 5 minutes after pneumoperitoneum, 10 minutes after trendelenburg position and 10 minutes after making the patient supine at the end of surgery. Change in the distance will be noted to confirm the migration of ETT.

Inclusion Criteria:

• Robotic uro-oncological surgical procedures of perineum
• Robotic gynae-oncological surgical procedures of perineum

Exclusion Criteria:

• Upper airway fibrosis or tracheal stenosis
• Large neck swelling distorting or deviating the trachea.
• Head and neck surgeries
• Laryngeal and tracheal tumour
• Tracheal surgery
• Previous tracheostomy
• previous radiation treatment of neck